American Pain Society

For immediate release

Contact: Chuck Weber, (262) 473-3018

News from The Journal of Pain

American Pain Society Publishes

Clinical Practice Guideline for Post-
surgical Pain Management
Evidence-based recommendations support using a variety of
analgesic medications and techniques as well as non-
pharmacological interventions

CHICAGO, Feb. 17, 2016 -- The American Pain Society has released a
new evidence-based clinical practice guideline, appearing in The
Journal of Pain, with 32 recommendations to help clinicians achieve
optimal pain management following surgery. According to numerous
studies, the majority of surgical patients receive inadequate pain
relief, which can heighten the risk for prolonged post-surgical pain,
mood disorders and physical impairment.

"The intent of the guideline is to provide evidence-based

recommendations for better management of postoperative pain, and
the target audience is all clinicians who manage pain resulting from
surgery," said Roger Chou, MD, lead author and head of the Oregon
Evidence-based Practice Center.

Chou said the key recommendation in the guideline, based on high-

quality evidence, is wider use of a variety of analgesic medications
and techniques.

"The guideline strongly advises use of multimodal anesthesia that

target different mechanisms of actions in the peripheral and central
nervous systems," he said.
 "Randomized trails have shown that multimodal anesthesia
involving simultaneous use of combinations of several medications
-- acting on different pain receptors or administered through
different techniques -- are associated with superior pain relief and
decreased opioid consumption compared with use of a single
medication administered by one technique."

Chou added that evidence also indicates that non-pharmacological

therapies, such as cognitive behavioral therapies and
transcutaneous elective nerve stimulation, can be effective
adjuncts to pharmacological therapies. Written by a 23-member
expert panel representing anesthesia, pain management, surgery,
nursing and other medical specialties, the APS guideline is based on
the panel's review of more than 6,500 scientific abstracts and
primary studies.

The guideline's 32 recommendations are rated as strong, moderate

or weak based on scientific evidence cited as high, moderate or low
quality. The recommendations are based on the premise that
optimal pain management begins in the preoperative period and
should be based on assessment of the patient and development of
individual care plans for the surgical procedure involved.

Three other recommendations in the APS guideline are graded

strong with high-quality evidence. They are:

Adults and children can be given acetaminophen and/or non-

steroidal anti-inflammatory drugs as part of multimodal analgesia
for management of postoperative pain

Clinicians should consider surgical site-specific peripheral

regional anesthetic techniques with proven efficacy in adults and
children for certain procedures

Spinal analgesia is appropriate for major thoracic and

abdominal procedures, particularly in patients at risk for cardiac
and pulmonary complications or prolonged intestinal distress.
 The APS Guideline offers 11 other strong recommendations, based
on moderate or weak evidence. They include:

Clinicians should provide patient and family-centered,

individually tailored education to patients and caregivers about
treatment options for postoperative pain

Oral administration of opioids is preferred to intravenous

administration for post-operative analgesia

Intravenous patient-controlled analgesia (PCA) can be used

when parenteral administration of analgesics is required

Clinicians should consider giving preoperative doses of

celecoxib (Celebrex) in appropriate adult patients

Gabapentin (Neurotin, Gralise, Horizant) and pregabalin

(Lyrica) can be considered for multimodal postoperative analgesia.
The medications are associated with lower opioid requirements
after surgery.

Surgical facilities should provide clinicians with access to a

pain specialist for patients with inadequately controlled
postoperative pain.

The APS postoperative pain management guideline was endorsed

by the American Society for Regional Anesthesia.

About the American Pain Society

Based in Chicago, the American Pain Society (APS) is a
multidisciplinary community that brings together a diverse group of
scientists, clinicians and other professionals to increase the
knowledge of pain and transform public policy and clinical practice
to reduce pain-related suffering. APS is the professional home for
investigators involved in all aspects of pain research including
basic, translational, clinical and health services research to obtain
the support and inspiration they need to flourish professionally. APS
strongly advocates expansion of high quality pain research to help
advance science to achieve effective and responsible pain relief.
For more information on APS, visit www.americanpainsociety.org.

Note to journalists: The Journal of Pain is the peer-reviewed

publication of the American Pain Society. To receive a pdf file of the
APS Postoperative Pain Management Clinical Practice Guideline,
email Chuck Weber at cpweber@weberpr.com.