Pain and Management of Pain: A Clinical Review for Craniofacial Surgeons

Frequently, aches, and pain are symptoms, like alarms alerting the occurrences of dangerous events which can cause cell death, tissue destruction, and inflammation. Physicians treat the underlying diseases which cause the pain and aches in order to restore health. On some occasions, the treatments are directed at aches and pains themselves, and are thus symptomatic relief. For surgeons, pain is an inevitable consequence of what we do in the operating room. Postoperative pain management represents an important part of the Enhanced Recovery After Surgery (ERAS) protocols. Furthermore, opioid epidemic has cost a great burden on the society and the healthcare system, which also places an emphasis on using non-opioid analgesics to achieve adequate pain relief. Unlike other vital signs, there is no objective, direct measurement of pain, even though pain is considered the fourth vital sign. Pain is a perceived sensation, as a result of nociception, a complex process which can extend from other somatosensory modalities such as thermoception, chemoception, and mechanoception. Whenever the stimulus magnitude exceeds nominal physiologic boundaries, cell death, and tissue injury follow, as does afferent nociceptive signals. This review is to provide craniofacial surgeons with an update on pain, what pain is, how to assess it, pharmacology of pain relief, and specifically, the proper use of opioids and non-narcotic analgesic agents. The goal is to allow for the optimal, rational use of these medications to relief pain with the minimum short and long term risks. With evidence-based, data-driven approach, supplemented by group experience pooled from senior surgeons after 100,000 patient-hours, the objective is to answer the following: (1) What is pain? (2) How does opioid work? (3) What is the role of narcotic analgesics in craniofacial ERAS? (4) When should non-opioids be used and how?