Rationale for and approach to preoperative opioid weaning: a preoperative optimization protocol

Area of Science:

• Pain Management
• Surgical Outcomes
• Public Health

Background:

• Chronic opioid prescription for non-cancer pain faces scrutiny due to unfavorable risk-benefit ratios and the opioid epidemic.
• Preoperative opioid use is linked to worse surgical outcomes, increased postoperative pain, and higher healthcare costs.
• Evidence suggests preoperative opioid reduction can significantly improve patient outcomes.

Purpose of the Study:

• To propose preoperative opioid reduction as a mandatory component of surgical optimization for chronic pain patients.
• To highlight the need for viable pain management alternatives to facilitate opioid reduction.
• To introduce a practical outpatient program for preoperative optimization.

Main Methods:

• Review of existing literature on opioid use, surgical outcomes, and pain management.
• Development of a simple, resource-minimal outpatient preoperative optimization program.
• Focus on gentle opioid weaning/elimination and pain catastrophization reduction.

Main Results:

• Preoperative opioid use is associated with poorer surgical outcomes and increased healthcare expenditure.
• Opioid reduction pre-surgery may lead to substantial improvements in patient outcomes.
• The proposed program aims to facilitate opioid reduction through alternative pain management strategies.

Conclusions:

• Addressing preoperative opioid reduction is crucial for optimizing surgical outcomes in chronic pain patients.
• Effective pain management alternatives, including psychological approaches, are essential for successful opioid weaning.
• A targeted preoperative optimization program can enhance surgical recovery and mitigate risks associated with chronic opioid use.