The power of the psyche during patient anaesthesia: opioid use and postoperative pain

Opioids have long been the go-to when prescribing analgesia for postoperative pain. However, as we have discussed in previous articles within this column, there is growing concern about how many people prescribed opioids postoperatively become addicted to their pain relief (Mendes, 2020). There is therefore a push at present to find other options in pain management, and to manage the dosing of opioids with awareness in terms of both not giving more than required and for as minimal a time as possible in the interests of the patient, while also of course ensuring it is enough to provide therapeutic benefit.

Glare et al (2019) note that inappropriate opioid prescribing after surgery, particularly following discharge, is a major contributing factor to rising deaths in the United States from prescription opioids. Chronic post-surgical pain occurs in about 10% of patients who have undergone surgery, typically beginning as acute postoperative pain that is difficult to manage, and soon transitions into a persistent pain condition with neuropathic features unresponsive to opioids (Glare et al, 2019).