Acute Pain Management in Peripheral Artery Disease: A Holistic, Beyond-Opioids, Individualized Multimodal Approach

Peripheral artery disease (PAD) is quite prevalent, and its incidence will increase with aging of population. Pain is a key diagnostic feature of symptomatic PAD and has been linked to disease progression and poor quality of life. Symptom improvement is of utmost importance in PAD; therefore, optimal and comprehensive pain therapy is mandatory. However, the management of acute pain in PAD remains challenging due to the lack of high-quality evidence, the complex pathophysiological mechanisms of pain, and the high comorbidity of patients. On the other hand, inadequate pain control leads to several pathophysiological deviations, such as the aggravated neuroendocrine stress response, which may be detrimental in patients with PAD. Experts suggest that the management of acute pain in patients with vascular diseases should be oriented toward the underlying pathophysiological mechanisms of each modality and should follow a multifactorial approach. Although the exact pain pathways in PAD are still poorly understood and more probably multifactorial, they may be key to an effective, individualized, patient-centered, multimodal pain strategy. The aim of this review was to provide a holistic, beyond-opioids, individualized multimodal pain approach for patients with PAD.