The Journal of Bone and Joint Surgery (American). 2007;89:1343-1358.
doi:10.2106/JBJS.F.00906
© 2007 The Journal of Bone and Joint Surgery, Inc.
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Current Concepts Review

Preventing the Development of Chronic Pain After Orthopaedic Surgery with Preventive Multimodal Analgesic Techniques

Scott S. Reuben, MD1 and Asokumar Buvanendran, MD2

1 Department of Anesthesiology, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199. E-mail address: scott.reuben{at}bhs.org
2 Department of Anesthesiology, Rush University Medical Center, 1653 West Congress Parkway, Suite 739, Jelke Building, Chicago, IL 60612

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

The prevalences of complex regional pain syndrome, phantom limb pain, chronic donor-site pain, and persistent pain following total joint arthroplasty are alarmingly high.

Central nervous system plasticity that occurs in response to tissue injury may contribute to the development of persistent postoperative pain. Many researchers have focused on methods to prevent central neuroplastic changes from occurring through the utilization of preemptive or preventive multimodal analgesic techniques.

Multimodal analgesia allows a reduction in the doses of individual drugs for postoperative pain and thus a lower prevalence of opioid-related adverse events. The rationale for this strategy is the achievement of sufficient analgesia due to the additive effects of, or the synergistic effects between, different analgesics.

Effective multimodal analgesic techniques include the use of nonsteroidal anti-inflammatory drugs, local anesthetics, {alpha}-2 agonists, ketamine, {alpha}2-{delta} ligands, and opioids.


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