• Toby N Weingarten, Andreas H Taenzer, Nabil M Elkassabany, Linda Le Wendling, Olga Nin, and Michael L Kent.
• Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.
• Pain Med. 2018 Nov 1; 19 (11): 2296-2315.

ObjectiveIn the setting of an expanding prevalence of acute pain medicine services and the aggressive use of multimodal analgesia, an overview of systems-based safety gaps and safety concerns in the setting of aggressive multimodal analgesia is provided below.SettingExpert commentary.MethodsRecent evidence focused on systems-based gaps in acute pain medicine is discussed. A focused literature review was conducted to assess safety concerns related to commonly used multimodal pharmacologic agents (opioids, nonsteroidal anti-inflammatory drugs, gabapentanoids, ketamine, acetaminophen) in the setting of inpatient acute pain management.ConclusionsOptimization of systems-based gaps will increase the probability of accurate pain assessment, improve the application of uniform evidence-based multimodal analgesia, and ensure a continuum of pain care. While acute pain medicine strategies should be aggressively applied, multimodal regimens must be strategically utilized to minimize risk to patients and in a comorbidity-specific fashion.

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