Pain Medicine & Chronic Pain | Anesthesia Curriculum

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Pain Medicine and Chronic Pain

1. Foundations of Pain

Learn the basics of general anesthesia, the physiology of unconsciousness and an overview of the pharmacology.

4. Interesting Reads/Resources

Master the fundamentals of airway management and effective ventilation.

2. Acute Pain Management

Understand the key phases of general anesthesia.

5. Common Pain Syndromes

Ensure patient safety by assessing monitoring tools that track depth of anesthesia.

3. Chronic Pain Management

Learn the five core goals of anesthesia: analgesia, amnesia, anesthesia, akinesia, and autonomic control.

6. Special Topics in Pain

Be prepared to recognize complications and apply rescue algorithms effectively.

1. Foundations of Pain

IASP Pain Terminology

A great starting point for getting your language right: this website lays out clear definitions for different types of pain, including acute vs. chronic and key categories like nociceptive, neuropathic, and nociplastic pain.

Biopsychosocial Lens of Pain

This resource walks through pain using a biopsychosocial lens, showing how factors like mood, environment, and social context influence the pain experience. It’s helpful for shifting from a purely biomedical view to a more holistic understanding of pain.

Types of Pain

A more approachable overview that helps classify different types of pain and gives helpful examples of each kind.

2. Acute Pain Mangement

Assessment and Diagnosis

• Take a thorough pain history

• Perform a physical exam

https://www.uptodate.com/contents/approach-to-the-management-of-acute-pain-in-adults

Validated Pain Scales

• Induce with propofol/etomidate/ketamine or sevoflurane mask; maintain with volatile or TIVA.
• Ensures unconsciousness so patient doesn’t perceive surgery.
• Adjust infusion or vaporizer to keep patient unresponsive but hemodynamically stable.
• Confirm return of protective reflexes before extubation.

1. Hosseinzadeh H, Eidy M, EJ Golzari S, Vasebi M. Hemodynamic Stability during Induction of Anesthesia in ElderlyPatients: Propofol + Ketamine versus Propofol + Etomidate. J Cardiovasc Thorac Res 2013;5:51–4. https://doi.org/10.5681/jcvtr.2013.011.

2. Lu Z, Zheng H, Chen Z, Xu S, Chen S, Mi W, et al. Effect of Etomidate vs Propofol for Total Intravenous Anesthesia on Major Postoperative Complications in Older Patients: A Randomized Clinical Trial. JAMA Surg 2022;157:888. https://doi.org/10.1001/jamasurg.2022.3338.

Management Approaches

• Load with fentanyl/remifentanil ± adjuncts; top up before incision and closure.
• Blunts sympathetic surges, reduces peri-op opioid needs later.
• Combine with regional block when possible for opioid-sparing effect.
• Multimodal plan: NSAID or acetaminophen given early.

1. Kim SH, Stoicea N, Soghomonyan S, Bergese SD. Intraoperative use of remifentanil and opioid induced hyperalgesia/acute opioid tolerance: systematic review. Front Pharmacol 2014;5:108. https://doi.org/10.3389/fphar.2014.00108.

2. O’Neill A, Lirk P. Multimodal Analgesia. Anesthesiol Clin 2022;40:455–68. https://doi.org/10.1016/j.anclin.2022.04.002.

Multimodal Approaches

• Use succinylcholine for rapid airway control or rocuronium/vecuronium for maintenance.
• Provides still field and prevents reflex movement that could harm surgeon or patient.
• Titrate with nerve stimulator, aiming 0–1 twitch during surgery.
• Reverse with sugammadex or neostigmine/glycopyrrolate before wake-up.

1. Muñoz-Martínez T, Garrido-Santos I, Arévalo-Cerón R, Rojas-Viguera L, Cantera-Fernández T, Pérez-González R, et al. [Contraindications to succinylcholine in the intensive care unit. A prevalence study]. Med Intensiva 2015;39:90–6. https://doi.org/10.1016/j.medin.2014.07.002.

2. Bucheery BA, Isa HM, Rafiq O, Almansoori NA, Razaq ZAA, Gawe ZA, et al. Residual Neuromuscular Blockade and Postoperative Pulmonary Complications in the Post-anesthesia Care Unit: A Prospective Observational Study. Cureus n.d.;15:e51013. https://doi.org/10.7759/cureus.51013.

5 A's of Anesthesia Explained