Factors influencing optimal postoperative pain management: a systematic scoping review

Effective postoperative pain management is a critical component of surgical care, directly influencing patient recovery, satisfaction, and long-term outcomes. Despite recent advances in pain management, postoperative pain remains poorly managed worldwide, suggesting that postoperative pain outcomes are influenced by several factors beyond the inherent efficacy of available treatments. The aim of this scoping review was to map the factors influencing postoperative pain management and to generate interventions that support optimal, evidence-based pain management after surgery. Articles published until September 2025 were identified through a systematic search of the following electronic databases: PubMed (MEDLINE) via EBSCOhost, CINAHL (Cumulative Index to Nursing & Allied Health Literature) via EBSCOhost, and PsycINFO via EBSCOhost. Two reviewers independently conducted the screening of articles and data extraction. Barriers and enablers were synthesized using the Theoretical Domains Framework. Intervention strategies were generated by mapping the identified barriers onto the Capability, Opportunity, Motivation-Behavior model. Patient empowerment and active engagement in pain management, strong clinician-patient rapport, and structured, team-based and policy-driven support were identified as key enablers for optimizing postoperative pain management. On the other hand, a lack of knowledge and misconception about postoperative pain, capability gaps in assessing and managing pain, interprofessional and communication challenges, organizational and policy deficiencies, and resource and workforce constraints were key barriers to optimal postoperative pain management. Despite advancements in treatment options, the findings suggest that optimal pain management requires a multifaceted approach that addresses both individual and systemic challenges. These insights contribute to a deeper understanding of the barriers and enablers of effective pain management and highlight the need for targeted interventions across various levels of healthcare delivery.