Chronic pain conditions present unique challenges in anesthesia and perioperative care, as these patients often have altered pain pathways, opioid tolerance, psychological distress, and complex medication regimens. Chronic pain may result from musculoskeletal disorders, neuropathic pain, spinal conditions, cancer-related pain, or previous surgeries. Effective anesthesia management must address both the underlying pain condition and the acute surgical pain associated with procedures.

Patients with chronic pain frequently use long-term analgesics, including opioids, antidepressants, anticonvulsants, and anti-inflammatory medications. These drugs can affect anesthesia requirements, increase the risk of drug interactions, and complicate postoperative pain control. Opioid-tolerant patients may require higher doses for adequate analgesia while remaining at risk for respiratory depression and other side effects.

Preoperative assessment focuses on understanding the nature, duration, and severity of chronic pain, current treatments, and functional limitations. Psychological factors such as anxiety, depression, and pain catastrophizing are also considered, as they influence pain perception and recovery. Clear communication and expectation-setting are essential to avoid dissatisfaction and poorly controlled pain after surgery.

Anesthetic strategies for chronic pain patients emphasize multimodal analgesia, combining regional anesthesia, non-opioid medications, and targeted nerve blocks to reduce opioid dependence. Regional techniques provide effective pain relief while minimizing systemic side effects and improving early mobilization.

Postoperative pain management requires close monitoring and adjustment of analgesic plans. Inadequate pain control can delay recovery, increase hospital stay, and worsen chronic pain. Conversely, excessive opioid use increases the risk of sedation, respiratory depression, and prolonged dependence.

Through individualized pain management plans and collaboration with pain specialists, anesthesiology teams help improve surgical outcomes and quality of life for patients living with chronic pain.