A general principle of perioperative care is to optimize the patient’s condition, including the management of persistent pain, prior to a surgical procedure (Pasero, Quinn, Portenoy, McCaffery, & Rizos, 2011). If preexisting pain is poorly controlled preoperatively, the primary care provider or anesthesiologist should be contacted for appropriate orders.
A multimodal postoperative pain treatment plan, initiated preoperatively whenever possible, is essential in patients with underlying persistent pain. The American Society of Anesthesiologists (2012) recommends the continuation of opioid analgesics to prevent opioid withdrawal syndrome in patients who take them preoperatively for preexistent pain. Other clinicians provide similar recommendations (Ashraf, Wong, Ronayne, & Williams, 2004; Pasero, Quinn, Portenoy, McCaffery, & Rizos, 2011). It is important to remember that patients who have been taking opioids on a long-term basis preoperatively are likely to be opioid tolerant and may require higher postoperative opioid doses than opioid-naïve patients. Although most of the nonselective NSAIDs (e.g., ibuprofen, naproxen) should be discontinued prior to surgery if bleeding is a concern, some nonselective NSAIDs (nabumetone, meloxicam, choline magnesium trisalicylate, magnesium salicylate, and salsalate) and the COX-2 selective NSAID celecoxib have no effect on bleeding time and may be continued throughout the perioperative period (Ashraf, Wong, Ronayne, & Williams, 2004). Intravenous or oral acetaminophen, as part of a nonopioid foundation, can be added as well (Pasero & Stannard, 2010). Anticonvulsants and antidepressants, which are often administered for treatment of persistent neuropathic pain, should also be continued if taken preoperatively or added to the treatment plan if not taken preoperatively.