Managing Chronic Pain Before and After Unrelated Surgery

Patients living with chronic pain may require surgery for a condition unrelated to the source of their pain. For these patients, the perioperative period presents a unique challenge: clinicians must treat new acute surgical pain without destabilizing an established chronic pain regimen. Effective management therefore begins well before the operation and continues after the expected surgical pain has resolved.

Chronic pain is generally defined as pain lasting beyond normal healing, often for three months or longer. Management may include medications, physical therapy, psychological interventions, exercise, and complementary approaches. The National Center for Complementary and Integrative Health (NCCIH) notes that acupuncture, mindfulness meditation, yoga, tai chi, massage, and several other approaches may provide benefit for selected chronic pain conditions.¹ These therapies are not substitutes for perioperative analgesia, but maintaining safe and effective components of a patient's existing pain-management strategy may help preserve function and avoid unnecessary disruption. Dietary supplements and herbal products should be specifically reviewed before surgery because some may cause adverse effects or interact with medications.

Due to varying pain and medication sensitivities, thorough pre-surgery planning is particularly important for patients receiving long-term analgesic therapy for chronic pain. A 2024 consensus involving 15 professional organizations emphasized multidisciplinary, coordinated perioperative care for patients with chronic pain, opioid tolerance, or substance use disorders.² Before surgery, clinicians should establish the patient's baseline pain level, functional status, medication use, previous responses to pain treatment, and anticipated postoperative needs. When a pain specialist or primary clinician manages the patient's chronic therapy, involving that clinician can help prevent conflicting prescriptions or unintended changes in treatment.

Long-term opioid therapy deserves additional attention. Chronic opioids generally should not be abruptly discontinued solely because a patient is having surgery. Sudden discontinuation can precipitate withdrawal and worsen pain, while opioid tolerance may mean that standard postoperative doses provide inadequate analgesia. The CDC recommends avoiding rapid tapering or abrupt discontinuation in patients receiving established opioid therapy unless an immediate safety concern exists.³ For patients taking buprenorphine, contemporary multisociety guidance similarly recommends that it generally not be routinely stopped before surgery.⁴

During and immediately after surgery, a multimodal strategy is generally preferred. Depending on the patient and procedure, this can include acetaminophen, nonsteroidal anti-inflammatory drugs when appropriate, regional anesthesia or local anesthetic techniques, and other nonopioid analgesics. Patients with chronic pain should still receive treatment for their new surgical pain rather than having all symptoms attributed to their preexisting condition. Recent perioperative consensus guidance emphasizes individualized multimodal analgesia, functional recovery, regional techniques when suitable, and access to pain specialists for patients at greater risk of difficult postoperative pain.^2,5

Planning for discharge is equally important. If additional opioids were required for acute postoperative pain, the goal should generally be to reduce these as surgical pain improves and return the patient toward the preoperative regimen rather than allow a temporary postoperative escalation to become permanent. The CDC specifically recommends returning patients receiving long-term opioids to their baseline dosage as soon as clinically appropriate and developing a taper when additional around-the-clock opioids have been used for more than several days.³

Chronic pain is an ongoing condition that accompanies the patient through surgery—not an unrelated problem that disappears during perioperative care. Early communication, preservation of effective baseline therapies, multimodal treatment of new surgical pain, and coordinated follow-up can help patients recover from an unrelated operation without sacrificing long-term pain control.

References

National Center for Complementary and Integrative Health. Chronic pain and complementary health approaches: usefulness and safety. Updated January 2023. Accessed August 19, 2026. https://www.nccih.nih.gov/health/chronic-pain-and-complementary-health-approaches-usefulness-and-safety
Dickerson DM, Mariano ER, Szokol JW, et al. Multiorganizational consensus to define guiding principles for perioperative pain management in patients with chronic pain, preoperative opioid tolerance, or substance use disorder. Reg Anesth Pain Med. 2024;49(10):716-724. doi:10.1136/rapm-2023-104435
Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC clinical practice guideline for prescribing opioids for pain—United States, 2022. MMWR Recomm Rep. 2022;71(3):1-95. doi:10.15585/mmwr.rr7103a1
Kohan L, Potru S, Barreveld AM, et al. Buprenorphine management in the perioperative period: educational review and recommendations from a multisociety expert panel. Reg Anesth Pain Med. 2021;46(10):840-859. doi:10.1136/rapm-2021-103007
El-Boghdadly K, Levy N, Fawcett WJ, et al. Peri-operative pain management in adults: a multidisciplinary consensus statement from the Association of Anaesthetists and the British Pain Society. Anaesthesia. 2024. doi:10.1111/anae.16391