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JACS

Opioids and Pain Management

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This collection highlights contemporary challenges and innovations in surgical opioid stewardship and pain management, bringing together clinical trials, epidemiologic analyses, and health systems research that examine prescribing patterns, risk factors for persistent opioid use, and disparity across patient populations and care settings. The included studies explore strategies to reduce opioid exposure, while also addressing special populations, including patients on chronic opioids and those with complex pain syndromes. Collectively, these articles underscore the variability in prescribing practices, the global and socioeconomic dimensions of postoperative pain management, and the ongoing need for evidence-based, scalable approaches to optimize analgesia while minimizing opioid-related harm.

 Scroll to the CME Articles section for opportunities to earn AMA PRA Category 1 Credits™ related to this collection. 

Featured Articles

Pre- and Postoperative Prescription of Opioids and Benzodiazepines in the US

Across 15 million US surgical patients, 21% of opioid- and BZD-naïve individuals received these medications postoperatively, compared with 51% of patients with preoperative opioid and/or BZD exposure. At a national level, postoperative prescribing may be driven more by patients’ preexisting opioid and BZD use than by new surgical indications.

Peripheral Nerve Surgery in Patients with a Label of Complex Regional Pain Syndrome in the Extremities

New research challenges when surgeons should operate on complex regional pain syndrome patients. Study of 53 patients shows successful operation in 67% of patients regardless of specific diagnosis, suggesting more patients could benefit from surgical evaluation than previously thought.

Opioid Stewardship: Successful, Scalable, and Adaptable Departmental Opioid Reduction Program

A comprehensive departmental opioid reduction toolkit reduced discharge opioid prescriptions by 67.1% by introducing several low-cost, scalable interventions aligning patient prescriptions with need. We demonstrated a 3.4-fold increase in opioid-free discharges, reduced average prescriptions sizes, and reduced odds of post-discharge prescriptions.

Articles

Opioid Consumption and Fills after Surgery in Adults on High-Dose Prescription Opioids

Bicket, Mark C; McGee, Michael F; Gunaseelan, Vidhya; et al

Early Percutaneous Cryoneurolysis for Pain Control After Rib Fracture for Older Patients: A Prospective Randomized Clinical Trial

Forrester, Joseph D; Abreo, Anisha; Earley, Michelle; et al

Peripheral Nerve Surgery in Patients with a Label of Complex Regional Pain Syndrome in the Extremities

Raasveld, Floris V; Wolff, Margaux; Luan, Anna; et al

Postoperative Pain Management in the US vs Low- and Middle-Income Countries by US Surgeons

Linz, Matthew S; Parvin-Nejad, Fatemeh P; Srinivasan, Nivetha; et al

Opioid Prescribing Disparity in Traumatically Injured Patients

Smith, Sophia M; Adams, Rachel; Ha, Emily; et al

Impact of Nonhepatectomy Opioid Reduction Efforts on Posthepatectomy Opioid Prescription: Analysis of 2,005 Patients

Fields, Brittany C; Newhook, Timothy E; Prakash, Laura R; et al

Surgical Opioid Stewardship: From the Epidemic, Through the Pandemic, and Beyond

Podder, Sourav K; Koeneman, Scott; Fagenson, Alexander M; et al

Epidemiology and Outcomes Associated with New Persistent Opioid Use after Transabdominal Surgery

Ingason, Arnar B; Galenkamp, Amanda L; Jonsdottir, Freyja; et al

Predictive Value of Preoperative Pain Sketches in Lower Extremity Amputees Undergoing Secondary Targeted Muscle Reinnervation for Treatment of Neuropathic Pain

Raasveld, Floris V; Hao, David; Gomez-Eslava, Barbara; et al

Drivers of Variation in Opioid Prescribing after Common Surgical Procedures in a Large Multihospital Healthcare System

Zanocco, Kyle; Romanelli, Robert J; Meeker, Daniella; et al

Postoperative Opioid Prescribing via Rule-Based Guidelines Derived from In-Hospital Consumption: An Assessment of Efficacy Based on Postdischarge Opioid Use

Beaulieu-Jones, Brendin R; Berrigan, Margaret T; Marwaha, Jayson S; et al

CME Articles

April 2025

  • Surgical opioid stewardship: from the epidemic through the pandemic and beyond

January 2025

  • Epidemiology and outcomes associated with new persistent opioid use after transabdominal operation

September 2024

  • Drivers of variation in opioid prescribing after common surgical procedures in a large multihospital healthcare system

Access JACS CME

Podcast Episode

Episode 39: Postoperative Pain Management in the US vs Low- and Middle-Income Countries by US Surgeons

In this episode, Tom Varghese, MD, FACS, is joined by Ziad Sifri, MD, FACS, from Rutgers New Jersey Medical School, and Matthew Linz, MD, from Rutgers Robert Wood Johnson Medical School. They discuss Drs Sifri and Linz’s recent article, “Postoperative Pain Management in the US vs Low- and Middle-Income Countries by US Surgeons,” in which they found that surgeons in the US prescribe significantly more opioids after inguinal hernia repair compared with when they operate on short-term surgical trips to low- and middle-income countries, despite continued efforts to reduce opioid overprescription in the US.

Featured Video

Dr Eberlin discusses his recently published article in JACS, Peripheral Nerve Surgery in Patients with a Label of Complex Regional Pain Syndrome in the Extremities.