• Andreas Kopf, Anne Banzhaf, and Christoph Stein.
• Department of Anesthesiology and Intensive Care Medicine, Charité--Campus Benjamin Franklin Freie Universität Berlin, Hindenburgdamm 30, 12200 Berlin, Germany. andreas.kopf@charite.de
• Best Pract Res Clin Anaesthesiol. 2005 Mar 1;19(1):59-76.

AbstractThe chronic pain patient has certain distinctive features important for her/his perioperative management. Altered opioid sensitivity and behavior are the major points to be considered. The pre-anesthetic visit should therefore include questions regarding chronic pain and regular use of analgesics and coanalgesics, among others. Although a number of characteristics-including increased opioid demand, underreporting of pain, and non-compliance--are known, only a few specific recommendations are available, viz. adequate increase of opioid dose for analgesia, continuation of pre-operative opioids and coanalgesics to prevent withdrawal, and intensive education to strengthen the patient's coping potential. No differences between specific techniques for post-operative analgesia (e.g. systemic, patient-controlled or regional analgesia) have been shown so far.

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