ABSTRACT

Postoperative pain management in the spine patient is challenging. Patient expectations, preoperative pain severity, medication use, and social support may all contribute to the postoperative pain experience by a patient. Nociceptor activation travels via peripheral receptors to the spinal cord dorsal horn. In the dorsal horn, neurons communicate with ultimate transmission to the central nervous system, synapsing in the thalamus, and then to the somatosensory cortex. The potential of unrelieved or inadequately managed acute postsurgical pain is real. The development of persistent or chronic pain is underrecognized problem for the postoperative spine patient who does not have adequate pain control. Multimodal pain management following spine surgery entails treatment directed toward a variety of sources of pain. Preemptive pain management is the pretreatment of pain, to eliminate or decrease hypersensitivity of the nociceptors. Multimodal pain management's goal is to treat postoperative pain from both peripheral and central sources, utilizing a combination of medications with goal to decrease and minimize opioid use.