Perioperative pain management in the chemically dependent patient.

Chemical dependence constitutes a significant public health problem with immeasurable physical and psychological sequelae. Pain management is generally undertreated in this population because of the associated stigma and misconceptions about both pain and chemical dependence. The plan of care in the perioperative period is complicated by the increased incidence of related trauma, medical and psychiatric problems, and the risk for withdrawal. An overview of assessment, anesthetic considerations, pain management, postoperative care, and treatment modalities for chemical dependence is presented in this article. Perianesthesia nurses need to become competent and confident when caringfor this population by increasing their knowledge base and confronting long-held myths and biases. Adherence to established standards of care will help to promote clinician accountability and quality patient care.