Originally published by our sister publication, Pain Medicine News.

In response to a 2019 report from the Health and Human Services Pain Management Best Practice Inter-Agency Task Force, a group of 14 professional organizations—including the American Society of Anesthesiologists and the American Society of Regional Anesthesia and Pain Management, among others—have released a consensus statement of seven principles to guide providers and institutions in offering multimodal and individualized pain treatment to their patients.

“The fact that 14 professional health care organizations could agree on these seven principles means that the bar for acute perioperative pain management has been reset,” said lead author Edward R. Mariano, MD, MAS, FASA, a professor of anesthesiology and perioperative pain management at Stanford University School of Medicine, in California, in a press release. “The work product of this consortium can now form the basis of all future guidelines and influence the products of legislation and regulation that affect pain management for surgical patients.”

The group’s seven principles are:

• Clinicians should conduct a preoperative evaluation, including assessment of medical and psychological conditions, concomitant medications, history of chronic pain, substance use disorder, and previous postoperative treatment regimens and responses, to guide the perioperative pain management plan.
• Clinicians should use a validated pain assessment tool to track responses to postoperative pain treatments and adjust treatment plans accordingly.
• Clinicians should offer multimodal analgesia, or the use of a variety of analgesic medications and techniques combined with nonpharmacologic interventions, for the treatment of postoperative pain in adults.
• Clinicians should provide patient and family-centered, individually tailored education to the patient (and/or responsible caregiver), including information on treatment options for managing postoperative pain, and document the plan and goals for postoperative pain management.
• Clinicians should provide education to all patients (adult) and primary caregivers on the pain treatment plan, including proper storage and disposal of opioids and tapering of analgesics after hospital discharge.
• Clinicians should adjust the pain management plan based on adequacy of pain relief and presence of adverse events.
• Clinicians should have access to consultation with a pain specialist for patients who have inadequately controlled postoperative pain or are at high risk for inadequately controlled postoperative pain at their facilities (e.g., long-term opioid therapy, history of substance use disorder).

The principles, and the full consensus statement, were published in Regional Anesthesia & Pain Medicine (2022;47:118-127). However, this is just the start, said Mariano, who is a member of the Anesthesiology News editorial advisory board. Other statements also have been released since, such as those on the continuation of buprenorphine perioperatively for patients with opioid use disorder.

“There is still so much work to do,” Mariano continued in the press statement. “The formation of this consortium is a critical first step to widespread quality improvement in perioperative pain management for surgical patients across the country. Despite all the evidence generated across anesthesiology, pain medicine, and surgical specialties supporting the effectiveness of multimodal pain management, there continues to be unwarranted variation in the pain care that actual surgical patients receive.”