Subspecialty

Pain Medicine

Acute, chronic, cancer, and interventional.

Pain medicine spans acute postoperative pain management, chronic pain syndromes, cancer pain, and interventional procedures (epidural steroid injections, facet blocks, spinal cord stimulators). Multimodal, opioid-sparing approaches dominate modern practice.

Key concepts

Multimodal analgesia

Acetaminophen + NSAIDs + neuropathic agents (gabapentin/pregabalin) + regional + judicious opioid. Reduces opioid need by 30–50%.

Acute on chronic

Continue baseline opioids; add multimodal & regional; convert PO to IV equivalents during NPO periods.

Common chronic syndromes

Low back pain, neuropathic pain (diabetic, post-herpetic), CRPS, fibromyalgia, cancer pain.

Interventional

Epidural steroid injection, medial branch blocks → RFA, sympathetic blocks (stellate ganglion, celiac plexus), SCS/intrathecal pumps.

Monitoring

Numeric rating scale
Functional outcomes
Opioid risk tool

Common drugs

AcetaminophenIbuprofen/ketorolacGabapentin/pregabalinDuloxetineLidocaine infusionKetamine infusionMethadoneBuprenorphine

Clinical pearls

1Screen all chronic opioid patients for OUD — naloxone Rx, PDMP review.

2Ketamine infusion 0.1–0.3 mg/kg/h has growing evidence for acute and chronic pain.

References & Further Reading

1
Textbook
Gropper MA, Miller RD, Cohen NH, et al., eds. Miller's Anesthesia. 9th ed. Philadelphia: Elsevier; 2020.
2
Textbook
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, Ortega R, Sharar SR, Holt NF. Clinical Anesthesia. 8th ed. Philadelphia: Wolters Kluwer; 2017.
3
Textbook
Flood P, Rathmell JP, Shafer S. Stoelting's Pharmacology and Physiology in Anesthetic Practice. 5th ed. Philadelphia: Wolters Kluwer; 2015.

Citations are provided to direct further study. Always check the most current edition of guidelines and society recommendations — the information in this chapter is a teaching summary, not primary source material.