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Clinical Consequences of Inadequate Pain Relief: Barriers to Optimal Pain Management

Baratta, Jaime L. MD; Schwenk, Eric S. MD; Viscusi, Eugene R. MD

Plastic and Reconstructive Surgery: October 2014 - Volume 134 - Issue 4S-2 - p 15S–21S
doi: 10.1097/PRS.0000000000000681
Special Topics: Original Articles

Summary: Uncontrolled postoperative pain may result in significant clinical, psychological, and socioeconomic consequences. Not only does inadequate pain management following surgery result in increased morbidity and mortality but it also may delay recovery, result in unanticipated readmissions, decrease patient satisfaction, and lead to chronic persistent postsurgical pain. Pain is multifactorial in nature, and understanding both the complexity of pain and its side effects is imperative to achieving a successful surgical outcome. In this section, we review the consequences of pain as they pertain to plastic surgery with a focus on the impact of pain on the surgical stress response and risk of wound infections and the effect of improved pain control on flap surgery. Uncontrolled acute postoperative pain may lead to chronic persistent postsurgical pain, which has a high incidence in patients undergoing breast cancer surgery. To achieve optimal postoperative analgesia, one must recognize the barriers to effective pain management, including both physician/nursing-related barriers and patient-related barriers, as well as the increasingly common appearance of opioid-tolerant patients.

Philadelphia, Pa.

From the Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University.

Disclosure: Dr. Viscusi is a consultant and has received honoraria from Pacira Pharmaceuticals. His institution has received a research grant from Pacira Pharmaceuticals. Drs. Baratta and Schwenk do not have a financial interest in any of the products, devices, or drugs mentioned in this article.

Jaime L. Baratta, MD, 111 South 11th St, Suite 8290, Gibbon Building, Philadelphia, PA 19107,

©2014American Society of Plastic Surgeons