In this podcast, Dr. Kodsi, an adult medicine physician with expertise in palliative and pain medicine, addresses the challenging topic of chronic post-surgical pain management. He begins with an illustrative case of a 62-year-old retired teacher named Margaret who, despite a successful mastectomy and a cancer-free diagnosis, continues to experience significant pain affecting her quality of life. Dr. Kodsi emphasizes that chronic post-surgical pain is a prevalent issue, impacting approximately half of patients undergoing high-risk procedures, such as mastectomies. He highlights the importance of recognizing and addressing these pain issues as they often manifest in a general practice setting rather than in surgical or hospital environments.

Dr. Kodsi sheds light on his journey as a pain specialist, underlining the crucial role that general practitioners play in managing chronic pain. He insists on early collaboration between general practitioners, anesthetists, and pain specialists to prevent pain from becoming a long-term burden. Recognizing that the road to recovery can be disrupted by chronic pain, he introduces various interventions and strategies aimed at reducing the incidence of chronic pain in surgical patients.

A key focus of the lecture is the discussion of the factors that contribute to chronic post-surgical pain. Dr. Kodsi explains biological and psychological factors, emphasizing the role of demographic variables such as age and pre-existing psychological issues, including catastrophic beliefs about pain. Preoperative opioid use also emerges as a significant negative factor, complicating recovery and raising the risk of chronic pain outcomes. He encourages healthcare professionals to implement multimodal pain management strategies, focusing on preemptive analgesia to potentially mitigate hypersensitivity and its consequences.

As the lecture progresses, Dr. Kodsi reviews historical studies, including seminal surveys identifying the high prevalence of phantom limb pain and chronic pain following surgical interventions. He discusses the evolution of understanding chronic post-surgical pain and the classification criteria established over the years, highlighting the need for further understanding of pain mechanisms such as central sensitization and neuroplastic changes.

Delving into practical interventions, Dr. Kodsi outlines the objectives and mechanisms of various pain management strategies, including the use of diagnostic nerve blocks and the role of regional anesthesia. He emphasizes the concept of preventive analgesia, advocating for the administration of analgesics before surgical procedures to minimize the likelihood of developing chronic pain. The discussion includes a review of different analgesic agents and techniques, such as the use of gabapentinoids and corticosteroids, while addressing their respective risks and benefits during the preoperative and postoperative periods.

Moreover, he discusses the importance of assessing patients for neuropathic pain and the significance of opioid stewardship in managing postoperative pain. Dr. Kodsi highlights the necessity of transitioning patients off opioids whenever feasible and exploring alternative medications that could lower the chances of developing chronic post-surgical pain. He underscores the combination of pharmacological and non-pharmacological approaches as crucial to fostering better recovery outcomes for patients.

Chronic post surgical pain management Dr Anthony Kodsi

In conclusion, Dr. Kodsi emphasizes that effective management of chronic post-surgical pain begins with a recognition of the various risk factors involved, prompt preoperative planning, and collaborative pain management strategies. He calls upon general practitioners to actively participate in the prevention of chronic pain by understanding these dynamics and implementing immediate, evidence-based solutions to improve patient...