{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T08:16:53Z","timestamp":1778055413756,"version":"3.51.4"},"reference-count":44,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2017,11,29]],"date-time":"2017-11-29T00:00:00Z","timestamp":1511913600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns4:p>In this review, we discuss advances in acute pain management, including the recent report of the joint American Pain Society and American Academy of Pain Medicine task force on the classification of acute pain, the role of psychosocial factors, multimodal pain management, new non-opioid therapy, and the effect of the \u201copioid epidemic\u201d. In this regard, we propose that a fundamental principle in acute pain management is identifying patients who are most at risk and providing an \u201copioid free anesthesia and postoperative analgesia\u201d. This can be achieved by using a multimodal approach that includes regional anesthesia and minimizing the dose and the duration of opioid prescription. This allows prescribing medications that work through different mechanisms. We shall also look at the recent pharmacologic and treatment advances made in acute pain and regional anesthesia.<\/ns4:p>","DOI":"10.12688\/f1000research.12286.1","type":"journal-article","created":{"date-parts":[[2017,11,29]],"date-time":"2017-11-29T07:10:27Z","timestamp":1511939427000},"page":"2065","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":74,"title":["Recent advances in acute pain management: understanding the mechanisms of acute pain, the prescription of opioids, and the role of multimodal pain therapy"],"prefix":"10.12688","volume":"6","author":[{"given":"Richa","family":"Wardhan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5715-5482","authenticated-orcid":false,"given":"Jacques","family":"Chelly","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2017,11,29]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"131-57","DOI":"10.1016\/j.jpain.2015.12.008","article-title":"Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council.","volume":"17","author":"R Chou","year":"2016","journal-title":"J Pain."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"479-89","DOI":"10.1016\/j.jpain.2017.02.421","article-title":"The ACTTION-APS-AAPM Pain Taxonomy (AAAPT) Multidimensional Approach to Classifying Acute Pain Conditions.","volume":"18","author":"M Kent","year":"2017","journal-title":"J Pain."},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"819-41","DOI":"10.1097\/AJP.0b013e31824549d6","article-title":"Preoperative anxiety and catastrophizing: a systematic review and meta-analysis of the association with chronic postsurgical pain.","volume":"28","author":"M Theunissen","year":"2012","journal-title":"Clin J Pain."},{"key":"ref-4","doi-asserted-by":"publisher","first-page":"215-22","DOI":"10.1016\/j.jpain.2015.10.011","article-title":"Beneficial Effects of Improvement in Depression, Pain Catastrophizing, and Anxiety on Pain Outcomes: A 12-Month Longitudinal Analysis.","volume":"17","author":"E Scott","year":"2016","journal-title":"J Pain."},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"2750-6","DOI":"10.1016\/j.arth.2016.05.056","article-title":"Preoperative Predictors of Pain Catastrophizing, Anxiety, and Depression in Patients Undergoing Total Joint Arthroplasty.","volume":"31","author":"T Wood","year":"2016","journal-title":"J Arthroplasty."},{"key":"ref-6","doi-asserted-by":"publisher","first-page":"1240-9","DOI":"10.1001\/jama.2016.2323","article-title":"Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial.","volume":"315","author":"D Cherkin","year":"2016","journal-title":"JAMA."},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"514-30","DOI":"10.7326\/M16-2367","article-title":"Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians.","volume":"166","author":"A Qaseem","year":"2017","journal-title":"Ann Intern Med."},{"key":"ref-8","doi-asserted-by":"publisher","first-page":"2173-81","DOI":"10.1080\/09638288.2016.1224936","article-title":"Implementing multimodal pain rehabilitation in primary care - a health care professional perspective.","volume":"39","author":"G Stenberg","year":"2017","journal-title":"Disabil Rehabil."},{"key":"ref-9","doi-asserted-by":"publisher","first-page":"691-7","DOI":"10.1001\/jamasurg.2017.0898","article-title":"Postoperative Multimodal Analgesia Pain Management With Nonopioid Analgesics and Techniques: A Review.","volume":"152","author":"E Wick","year":"2017","journal-title":"JAMA Surg."},{"key":"ref-10","doi-asserted-by":"publisher","first-page":"248-73","DOI":"10.1097\/ALN.0b013e31823c1030","article-title":"Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management.","volume":"116","year":"2012","journal-title":"Anesthesiology."},{"key":"ref-11","doi-asserted-by":"publisher","first-page":"992-1000","DOI":"10.1007\/s00535-013-0905-z","article-title":"Aspirin and non-aspirin NSAIDs increase risk of colonic diverticular bleeding: a systematic review and meta-analysis.","volume":"49","author":"H Yuhara","year":"2014","journal-title":"J Gastroenterol."},{"key":"ref-12","doi-asserted-by":"publisher","first-page":"822-31","DOI":"10.1097\/00000542-200504000-00019","article-title":"Efficacy and safety of single and repeated administration of 1 gram intravenous acetaminophen injection (paracetamol) for pain management after major orthopedic surgery.","volume":"102","author":"R Sinatra","year":"2005","journal-title":"Anesthesiology."},{"key":"ref-13","doi-asserted-by":"publisher","first-page":"290-6","DOI":"10.1111\/j.1533-2500.2010.00426.x","article-title":"A literature review of randomized clinical trials of intravenous acetaminophen (paracetamol) for acute postoperative pain.","volume":"11","author":"A Macario","year":"2011","journal-title":"Pain Pract."},{"key":"ref-14","doi-asserted-by":"publisher","first-page":"125-30","DOI":"10.1111\/anae.12972","article-title":"Tramadol - the Marmite(\u2122) drug.","volume":"70","author":"B Gibbison","year":"2015","journal-title":"Anaesthesia."},{"key":"ref-15","doi-asserted-by":"publisher","first-page":"749837","DOI":"10.1155\/2015\/749837","article-title":"Role of ketamine in acute postoperative pain management: a narrative review.","volume":"2015","author":"B Radvansky","year":"2015","journal-title":"Biomed Res Int."},{"key":"ref-16","doi-asserted-by":"publisher","first-page":"1088-100","DOI":"10.1111\/pme.12094","article-title":"Effects of low-dose IV ketamine on peripheral and central pain from major limb injuries sustained in combat.","volume":"14","author":"R Polomano","year":"2013","journal-title":"Pain Med."},{"key":"ref-17","doi-asserted-by":"publisher","first-page":"311-25","DOI":"10.1007\/s12630-015-0551-4","article-title":"Ketamine added to morphine or hydromorphone patient-controlled analgesia for acute postoperative pain in adults: a systematic review and meta-analysis of randomized trials.","volume":"63","author":"L Wang","year":"2016","journal-title":"Can J Anaesth."},{"key":"ref-18","doi-asserted-by":"publisher","first-page":"383-403","DOI":"10.1111\/pme.12619","article-title":"The use of intravenous infusion or single dose of low-dose ketamine for postoperative analgesia: a review of the current literature.","volume":"16","author":"J Jouguelet-Lacoste","year":"2015","journal-title":"Pain Med."},{"key":"ref-19","doi-asserted-by":"publisher","first-page":"e012190","DOI":"10.1136\/bmjopen-2016-012190","article-title":"Study protocol of a randomised controlled trial of intranasal ketamine compared with intranasal fentanyl for analgesia in children with suspected, isolated extremity fractures in the paediatric emergency department.","volume":"6","author":"S Reynolds","year":"2016","journal-title":"BMJ Open."},{"key":"ref-20","doi-asserted-by":"publisher","first-page":"411-4","DOI":"10.1056\/NEJMp1704633","article-title":"Gabapentin and Pregabalin for Pain - Is Increased Prescribing a Cause for Concern?","volume":"377","author":"C Goodman","year":"2017","journal-title":"N Engl J Med."},{"key":"ref-21","doi-asserted-by":"publisher","first-page":"e3883","DOI":"10.1097\/MD.0000000000003883","article-title":"The use of gabapentin in the management of postoperative pain after total knee arthroplasty: A PRISMA-compliant meta-analysis of randomized controlled trials.","volume":"95","author":"C Han","year":"2016","journal-title":"Medicine (Baltimore)."},{"key":"ref-22","doi-asserted-by":"publisher","first-page":"1165-73","DOI":"10.1080\/03007995.2017.1310092","article-title":"Multimodal analgesia in moderate-to-severe pain: a role for a new fixed combination of dexketoprofen and tramadol.","volume":"33","author":"G Varrassi","year":"2017","journal-title":"Curr Med Res Opin."},{"key":"ref-23","doi-asserted-by":"publisher","first-page":"524-9","DOI":"10.1016\/j.jclinane.2016.08.041","article-title":"Peripheral nerve blocks in the management of postoperative pain: challenges and opportunities.","volume":"35","author":"G Joshi","year":"2016","journal-title":"J Clin Anesth."},{"key":"ref-24","doi-asserted-by":"publisher","first-page":"E111-E116","DOI":"10.25011\/cim.v40i3.28390","article-title":"Addition of dexmedetomidine to bupivacaine in supraclavicular brachial plexus block.","volume":"40","author":"R Aksu","year":"2017","journal-title":"Clin Invest Med."},{"key":"ref-25","doi-asserted-by":"publisher","first-page":"167-81","DOI":"10.1093\/bja\/aew411","article-title":"Evidence basis for using perineural dexmedetomidine to enhance the quality of brachial plexus nerve blocks: a systematic review and meta-analysis of randomized controlled trials.","volume":"118","author":"L Vorobeichik","year":"2017","journal-title":"Br J Anaesth."},{"key":"ref-26","doi-asserted-by":"publisher","first-page":"873-85","DOI":"10.1097\/ALN.0000000000000831","article-title":"A Phase 1, Dose-escalation, Double-blind, Block-randomized, Controlled Trial of Safety and Efficacy of Neosaxitoxin Alone and in Combination with 0.2% Bupivacaine, with and without Epinephrine, for Cutaneous Anesthesia.","volume":"123","author":"K Lobo","year":"2015","journal-title":"Anesthesiology."},{"key":"ref-27","doi-asserted-by":"publisher","first-page":"319-26","DOI":"10.1097\/AAP.0000000000000571","article-title":"Perineural Versus Intravenous Dexamethasone as an Adjuvant for Peripheral Nerve Blocks: A Systematic Review and Meta-Analysis.","volume":"42","author":"M Chong","year":"2017","journal-title":"Reg Anesth Pain Med."},{"key":"ref-28","doi-asserted-by":"publisher","first-page":"1117-8","DOI":"10.1001\/jama.2017.0935","article-title":"History of The Joint Commission's Pain Standards: Lessons for Today's Prescription Opioid Epidemic.","volume":"317","author":"D Baker","year":"2017","journal-title":"JAMA."},{"key":"ref-29","first-page":"8-9","article-title":"The opioid abuse epidemic: How healthcare helped create a crisis.","volume":"46","author":"S Johnson","year":"2016","journal-title":"Mod Healthc."},{"key":"ref-30","article-title":"Prescription Drug Use and Misuse in the United States: Results from the 2015 National Survey on Drug Use and Health","author":"A Hughes"},{"key":"ref-31","article-title":"Home and recreational safety: unintentional poisoning [Internet]."},{"key":"ref-32","doi-asserted-by":"publisher","first-page":"265-9","DOI":"10.15585\/mmwr.mm6610a1","article-title":"Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use - United States, 2006\u20132015.","volume":"66","author":"A Shah","year":"2017","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"ref-33","doi-asserted-by":"publisher","first-page":"947-957.e3","DOI":"10.1016\/j.jhsa.2016.07.113","article-title":"Risk of Prolonged Opioid Use Among Opioid-Na\u00efve Patients Following Common Hand Surgery Procedures.","volume":"41","author":"S Johnson","year":"2016","journal-title":"J Hand Surg Am."},{"key":"ref-34","doi-asserted-by":"publisher","first-page":"1429-37","DOI":"10.2147\/DDDT.S109331","article-title":"New developments in managing opioid addiction: impact of a subdermal buprenorphine implant.","volume":"11","author":"M Itzoe","year":"2017","journal-title":"Drug Des Devel Ther."},{"key":"ref-35","doi-asserted-by":"publisher","first-page":"1462-9","DOI":"10.1377\/hlthaff.2012.0846","article-title":"A call for evidence-based medical treatment of opioid dependence in the United States and Canada.","volume":"32","author":"B Nosyk","year":"2013","journal-title":"Health Aff (Millwood)."},{"key":"ref-36","doi-asserted-by":"publisher","first-page":"e115-e143","DOI":"10.1016\/j.anclin.2017.01.018","article-title":"Essential Elements of Multimodal Analgesia in Enhanced Recovery After Surgery (ERAS) Guidelines.","volume":"35","author":"A Beverly","year":"2017","journal-title":"Anesthesiol Clin."},{"key":"ref-37","doi-asserted-by":"publisher","first-page":"49-54","DOI":"10.5603\/AIT.2016.0006","article-title":"Anaesthetic perioperative management according to the ERAS protocol.","volume":"48","author":"B Horosz","year":"2016","journal-title":"Anaesthesiol Intensive Ther."},{"key":"ref-38","doi-asserted-by":"publisher","first-page":"e0170410","DOI":"10.1371\/journal.pone.0170410","article-title":"Muscle Reactive Oxygen Species (ROS) Contribute to Post-Incisional Guarding via the TRPA1 Receptor.","volume":"12","author":"D Sugiyama","year":"2017","journal-title":"PLoS One."},{"key":"ref-39","doi-asserted-by":"publisher","first-page":"5954890","DOI":"10.1155\/2016\/5954890","article-title":"Emerging Role of Spinal Cord TRPV1 in Pain Exacerbation.","volume":"2016","author":"S Choi","year":"2016","journal-title":"Neural Plast."},{"key":"ref-40","doi-asserted-by":"publisher","first-page":"1620-36","DOI":"10.1097\/j.pain.0000000000000224","article-title":"Induction of thermal and mechanical hypersensitivity by parathyroid hormone-related peptide through upregulation of TRPV1 function and trafficking.","volume":"156","author":"A Mickle","year":"2015","journal-title":"Pain."},{"key":"ref-41","doi-asserted-by":"publisher","first-page":"467-72","DOI":"10.1016\/j.amjsurg.2016.11.008","article-title":"Pharmacogenetics-guided analgesics in major abdominal surgery: Further benefits within an enhanced recovery protocol.","volume":"213","author":"A Senagore","year":"2017","journal-title":"Am J Surg."},{"key":"ref-42","doi-asserted-by":"publisher","first-page":"199-208","DOI":"10.1016\/j.pain.2006.09.022","article-title":"Catechol-O-methyltransferase inhibition increases pain sensitivity through activation of both beta2- and beta3-adrenergic receptors.","volume":"128","author":"A Nackley","year":"2007","journal-title":"Pain."},{"key":"ref-43","doi-asserted-by":"publisher","first-page":"559-66","DOI":"10.1038\/sj.clpt.6100385","article-title":"Association of ABCB1\/MDR1 and OPRM1 gene polymorphisms with morphine pain relief.","volume":"83","author":"D Campa","year":"2008","journal-title":"Clin Pharmacol Ther."},{"key":"ref-44","doi-asserted-by":"publisher","first-page":"e604","DOI":"10.1097\/PR9.0000000000000604","article-title":"\u201cAre perioperative opioids obsolete?: \u201d Proceedings of an IASP Acute Pain Special Interest Group Satellite Symposium September 25, 2016 Yokohama, Japan.","volume":"2","author":"D Carr","year":"2017","journal-title":"PAIN Reports."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/6-2065\/v1\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/6-2065\/v1\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/6-2065\/v1\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,3,29]],"date-time":"2019-03-29T12:50:52Z","timestamp":1553863852000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/6-2065\/v1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11,29]]},"references-count":44,"URL":"https:\/\/doi.org\/10.12688\/f1000research.12286.1","relation":{"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.13300.r28489","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.13300.r28488","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.13300.r28487","asserted-by":"subject"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11,29]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/6-2065\/v1#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.13300.r28489, Daniel Carr, Department of Anesthesia, Tufts Medical Center, Boston, MA, USA, 29 Nov 2017, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/6-2065\/v1#referee-response-28489","order":0,"name":"referee-response-28489","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.13300.r28487, Chester 'Trip' Buckenmaier III, Defense and Veterans Center for Integrative Pain Management, Rockville, MD, USA, 29 Nov 2017, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/6-2065\/v1#referee-response-28487","order":1,"name":"referee-response-28487","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.13300.r28488, Andr\u00e9 P. Boezaart, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA, 29 Nov 2017, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/6-2065\/v1#referee-response-28488","order":2,"name":"referee-response-28488","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}