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Perioperative Management of the Opioid-Tolerant Patient

  • Christopher Viscomi
    Correspondence
    Corresponding author. Department of Anesthesiology, University of Vermont/Fletcher Allen Healthcare, ACC WP2 GME, 111 Colchester Avenue, Burlington, VT 05401.
    Affiliations
    Department of Anesthesiology, University of Vermont/Fletcher Allen Healthcare, ACC WP2 GME, 111 Colchester Avenue, Burlington, VT 05401, USA

    Acute Pain Service, University of Vermont/Fletcher Allen Healthcare, ACC WP2 GME, 111 Colchester Avenue, Burlington, VT 05401, USA
    Search for articles by this author
  • Jared K. Pearson
    Affiliations
    Virginia Mason Medical Center, Graduate Medical Education, H8-925 Seneca Street, Seattle, WA 98101, USA
    Search for articles by this author
      There is no symptom more treated in the history of medicine than pain. As early as 3400 bc, the Sumerian civilization in Mesopotamia cultivated the opium poppy, and 2000 bc writings indicate that doctors crushed opium pods into sap, mixing several concoctions to treat a variety of ailments including pain. Further extraction and purification of opium eventually led to the isolation of morphine to aid in the treatment of pain [
      • Booth M.
      Opium: a history.
      ]. In modern medicine, acute or chronic pain is the chief complaint in nearly 80% of outpatient physician visits, representing the primary reason why Americans visit their doctor [
      • Walid M.S.
      • Donahue S.N.
      • Darmohray D.M.
      • et al.
      The fifth vital sign—what does it mean?.
      ,
      • Kalb C.
      Taking a new look at pain.
      ]. Furthermore, it is believed that the economic burden of pain in the United States alone is as high as $100 billion per year [
      • Walid M.S.
      • Donahue S.N.
      • Darmohray D.M.
      • et al.
      The fifth vital sign—what does it mean?.
      ]. Of course, the problem of pain is not unique to North America. According to a recent meta-analysis of international studies, the prevalence of chronic pain in adults is greater than 10% [
      • Harstall C.
      • Ospina M.
      How prevalent is chronic pain?.
      ]. Perhaps for this reason some physicians have called modern health care an epidemic of pain [
      • Bennet M.
      The congressional briefing: the epidemic of pain in America.
      ,
      • Aronoff G.M.
      Chronic pain and the disability epidemic.
      ].
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