Persistent Postsurgical Pain Management

Initial Management Approach

• The American College of Surgeons recommends acetaminophen (1g scheduled) as first-line therapy for all patients unless contraindicated 6
• The American Pain Society suggests adding NSAIDs or COX-2 inhibitors around-the-clock if no renal, cardiovascular, or bleeding contraindications exist 5
• The National Comprehensive Cancer Network guidelines recommend initiating gabapentinoids (gabapentin or pregabalin) for neuropathic pain components, which occur in approximately 70% of persistent postsurgical pain cases 5

Opioid Management Strategy

• The Journal of the National Comprehensive Cancer Network recommends using immediate-release opioid formulations (10-20% of 24-hour requirement) for breakthrough pain only, not scheduled 4, 5
• The American Pain Society guidelines suggest prophylactic laxatives must be prescribed with any opioid use to prevent constipation 5, 6