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Acute and Perioperative Pain Medicine and Orthopedic Surgery: A Crucial Partnership

Boezaart, André P. MD, PhD*; (Kiki) Nin, Olga C. MD*; Parvataneni, Hari K. MD

doi: 10.1097/BTO.0000000000000264

Departments of *Anesthesiology

Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL

The authors declare that they have nothing to disclose.

Many advances and innovations highlight the last 2 decades of orthopedic surgery. Improved pain management and accelerated rehabilitation programs stand out among these innovations. Procedures that were exclusively inpatient have transitioned or are transitioning to outpatient, and patients spend much less time in the hospital than 20, and even 10 or 5 years ago. Two decades ago in the United States, total joint replacement patients spent ≥4 nights in the hospital (and in some other countries, even longer); often not walking for 24 to 48 hours, but now they walk immediately after or within a few hours of surgery and often going home the day of surgery or after a 1-night hospital stay. Numerous partnerships have resulted in this dramatic advancement, but the one between Acute Pain Medicine specialists and Orthopedic surgeons has been the cornerstone. Patients in severe pain do not ambulate easily, nor can they go home quickly. There is also a shift in the culture taking place from “no pain” to “managed pain” and in placing the emphasis on function (sleep, ambulation, eat, drink, bowel and bladder function, etc.) and not on pain per se. This has been orchestrated by this partnership, and it seems that there is a movement away from the opioids, which negatively influence all these bodily functions.

The last 2 decades have also been the era of pain scores and of the opioid epidemic. In 1998, the initiative to make pain the fifth vital sign was introduced. The Joint Commission established standards for pain assessment and treatment in 2001, and the US Congress declared 2000 to 2010 as the decade of Pain Control and Research. Today, possibly as a consequence of this and many other factors, the United States has <5% of the world’s population but consumes 80% of the opioids in the world. Opioid consumption has more than doubled between 1999 and 2010. Orthopedic surgeons are the third highest prescribers of opioids. This prescription practice will also most probably be accelerated by the new trend that physicians are judged (and remunerated) on their patient satisfaction scores. This will no doubt further complicate the opioid epidemic that we are facing today.

How can it be that both of these dramatic changes occurred during the same time period? Partnership between Acute Pain Medicine specialists and Orthopedic surgeons can have a significant impact in both of these independent yet related areas. We proudly present this collection of review articles written by renowned experts in the field of Acute and Perioperative Pain Medicine and Orthopedic surgery. These articles reflect current knowledge as well as the state of the art and have been chosen to touch on different aspects of these areas.

The complex and elusive continuum of surgery, trauma, rehabilitation, acute pain, and chronic pain ideally should be handled through evidence- and outcomes-based partnerships. We hope you find these articles relevant, thought-provoking, and educational.

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