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Abstract
<p class="first" id="d11885107e90">Over the past decade there has been an increasing
reliance on strong opioids to treat
acute and chronic pain, which has been associated with a rising epidemic of prescription
opioid misuse, abuse, and overdose-related deaths. Deaths from prescription opioids
have more than quadrupled in the USA since 1999, and this pattern is now occurring
globally. Inappropriate opioid prescribing after surgery, particularly after discharge,
is a major cause of this problem. Chronic postsurgical pain, occurring in approximately
10% of patients who have surgery, typically begins as acute postoperative pain that
is difficult to control, but soon transitions into a persistent pain condition with
neuropathic features that are unresponsive to opioids. Research into how and why this
transition occurs has led to a stronger appreciation of opioid-induced hyperalgesia,
use of more effective and safer opioid-sparing analgesic regimens, and non-pharmacological
interventions for pain management. This Series provides an overview of the epidemiology
and societal effect, basic science, and current recommendations for managing persistent
postsurgical pain. We discuss the advances in the prevention of this transitional
pain state, with the aim to promote safer analgesic regimens to better manage patients
with acute and chronic pain.
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