In the twelfth episode of The Saving Dose, Dr. John Hsu and William Pedranti are joined by Professor Patrice Forget, a Belgian anesthesiologist and pain researcher now based in the United Kingdom. With more than 250 peer-reviewed publications, Professor Forget chairs the PANDOS research group (Pain and Opioids After Surgery) at the European Society of Anesthesiology and Intensive Care, serves as a board member and honorary treasurer of the European Pain Federation, and is deputy editor-in-chief of the European Journal of Anesthesiology. His work bridges clinical practice, large-scale epidemiology, and policy at the intersection of post-operative pain management, opioid use, and long-term outcomes.

This episode goes further into the clinical science of opioids than any conversation The Saving Dose has had. Professor Forget challenges assumptions that have shaped prescribing practice for decades, including the idea that more opioids during surgery means less pain after it.

00:00 Introduction
02:06 Professor Forget's background and path from Brussels to the UK
04:00 How fentanyl was developed in Belgium and what it was originally designed to do
07:15 Opioid-induced hyperalgesia: what it is and why it matters
10:00 The Liverpool technique and the history of balanced anesthesia
12:00 Why large doses of opioids can increase pain sensitivity rather than reduce it
16:00 The preemptive analgesia theory and why the data rejected it
20:00 How not all patients respond to opioids the same way
24:00 What European post-surgical data shows about long-term opioid outcomes
28:00 The gap between what research shows and what policy assumes
32:00 Opioid stewardship and responsible prescribing in a post-crisis environment
38:00 John on cardiac anesthesia and the clinical reality of high-dose opioid use
44:00 What the field still does not know and where research is heading
50:00 What better perioperative pain management could mean for addiction prevention

About the Hosts

John Hsu, MD is the Founder and CEO of iPill and a practicing anesthesiologist with 25 years in pain management and addiction medicine. He has taken multiple products through FDA approval and commercial launch.

William Pedranti is the COO of iPill, a Georgetown Law graduate, and co-founder of PENG Life Science Ventures. He has taken a biotech company from founding through FDA approval, commercial launch, and exit.


About the Guest

Professor Patrice Forget is a Belgian anesthesiologist and pain researcher based in the United Kingdom. He chairs the PANDOS (Pain and Opioids After Surgery) research group at the European Society of Anesthesiology and Intensive Care and serves as a board member and honorary treasurer of the European Pain Federation. He is deputy editor-in-chief of the European Journal of Anesthesiology and a past president of the Belgian Pain Society. He has authored more than 250 peer-reviewed publications on perioperative epidemiology, clinical pharmacology, and opioid stewardship.

Website: thesavingdose.com

This podcast is for educational purposes only and does not constitute medical advice. Consult a qualified healthcare professional before making any treatment decisions.


If you or someone you know is struggling with substance use disorder, contact SAMHSA's National Helpline at 1-800-662-4357. Free, confidential, 24/7.

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