Postoperative Pain Management and Opioid Use

Effective management of pain following surgery is essential to promote recovery, reduce complications and enhance patient satisfaction. Historically, opioids have formed the cornerstone of postoperative analgesia due to their potent efficacy, yet their use carries well-documented risks including respiratory depression, gastrointestinal dysfunction and potential for long-term dependence. Recognition of these hazards has spurred a shift towards multimodal strategies that combine regional techniques, non-opioid pharmacotherapies and tailored dosing to minimise opioid exposure. Despite evidence that aggressive perioperative opioid prescribing can precipitate persistent postsurgical pain and chronic opioid use, wide variability persists in prescribing practices across institutions and regions. Patient factors such as age, comorbidities and psychological profile, together with system factors like guideline adherence and discharge protocols, interact to determine both analgesic effectiveness and safety outcomes. Global efforts now emphasise enhanced recovery pathways, patient education on safe storage and disposal, and the integration of adjuvant agents to balance robust pain control with mitigation of opioid-related harm.

Research from Nature Portfolio

Analyses of international pharmaceutical sales data have revealed a pronounced and sustained rise in gabapentinoid use over the past decade, with average annual growth exceeding 17% across 65 countries. By 2018, consumption in high-income regions was more than six times that of lower-middle-income areas. These trends reflect an expanding role for gabapentinoids as adjuncts in multimodal regimens aimed at reducing perioperative opioid requirements. At the same time, the findings highlight disparities in regulatory oversight and raise concerns about off-label use, underscoring the necessity for standardised prescribing guidelines and long-term evaluation of safety profiles alongside opioid-sparing benefits.

Postoperative Pain Management and Opioid Use publication trend

The graph below shows the total number of articles in postoperative pain management and opioid use across all publications each year (not limited to Nature Index journals).

Technical terms

Multimodal analgesia: Use of multiple agents or techniques that target different pain pathways to improve pain control and reduce reliance on opioids.

Gabapentinoids: A class of anticonvulsant medications (including gabapentin and pregabalin) used as adjuvant analgesics to attenuate neuropathic and postoperative pain.

Patient-controlled analgesia (PCA): A method allowing patients to self-administer predetermined doses of analgesic medication, commonly opioids, via a programmable pump.

Peripheral nerve blockade: Regional anaesthetic technique involving injection of local anaesthetic near specific nerves to provide targeted pain relief.

Morphine milligram equivalents (MME): A standardised measure converting various opioid dosages to an equivalent amount of morphine to facilitate safe prescribing and comparison.

Persistent postsurgical pain: Chronic pain that persists for months after surgery, beyond the expected period of healing.

References

1. Changes in opioid prescribing during the COVID-19 pandemic in England: an interrupted time-series analysis in the OpenSAFELY-TTP cohort. The Lancet Public Health (2024).
2. Gabapentinoid consumption in 65 countries and regions from 2008 to 2018: a longitudinal trend study. Nature Communications (2023).
3. Opioid Use and Storage Patterns by Patients after Hospital Discharge following Surgery. PLOS ONE (2016).
4. Postoperative Pain Management in Total Knee Arthroplasty. Orthopaedic Surgery (2019).