Yu Crystal, Madsen Michael, Akande Olutola, Oh Michael Y, Mattie Ryan, Lee David W
School of Medicine, University of California, Irvine, Irvine, CA, USA.
University of California, Irvine; Department of Neurological Surgery, Irvine, CA, USA.
Neurospine. 2025 Jun;22(2):403-420. doi: 10.14245/ns.2550410.205. Epub 2025 Jun 30.
Postoperative pain is an inevitable consequence of spine surgery, yet there remains no universal consensus on the optimal pain management strategy. The complexity of spine procedures, coupled with patient variability, necessitates a multifaceted approach to pain control. Over time, numerous strategies have emerged, each with varying levels of effectiveness. Pharmacological approaches, including multimodal analgesia, local anesthetic infusions, and gabapentinoids, provide relief for both acute and chronic pain. Additionally, perioperative strategies such as enhanced recovery after surgery (ERAS) protocols have demonstrated benefits in optimizing pain control and recovery outcomes. Beyond pharmacological interventions, physical therapy has become a cornerstone of postoperative pain management, aiding in functional recovery and reducing reliance on medications. For patients with refractory or chronic pain, neuromodulatory techniques such as spinal cord stimulation and intrathecal injections offer alternative solutions. Despite the breadth of evidence-based strategies available, limitations persist, including opioid dependence, the complexity of multimodal regimens leading to suboptimal compliance, and cases of refractory pain. These challenges underscore the importance of tailoring pain management approaches to individual patient needs, ensuring a balance between effectiveness and safety. This narrative review of evidence seeks to explore the multifaceted nature of pain management following spine surgery, highlighting the challenges and evolving strategies in optimizing patient outcomes.
术后疼痛是脊柱手术不可避免的后果，但对于最佳疼痛管理策略尚未达成普遍共识。脊柱手术的复杂性，加上患者的个体差异，需要采用多方面的方法来控制疼痛。随着时间的推移，出现了许多策略，每种策略的效果各不相同。药物治疗方法，包括多模式镇痛、局部麻醉药输注和加巴喷丁类药物，可缓解急性和慢性疼痛。此外，围手术期策略，如术后加速康复（ERAS）方案，已证明在优化疼痛控制和恢复结果方面具有益处。除了药物干预外，物理治疗已成为术后疼痛管理的基石，有助于功能恢复并减少对药物的依赖。对于难治性或慢性疼痛患者，脊髓刺激和鞘内注射等神经调节技术提供了替代解决方案。尽管有广泛的循证策略可用，但仍存在局限性，包括阿片类药物依赖、多模式治疗方案的复杂性导致依从性欠佳以及难治性疼痛病例。这些挑战凸显了根据患者个体需求定制疼痛管理方法的重要性，确保在有效性和安全性之间取得平衡。这篇证据叙述性综述旨在探讨脊柱手术后疼痛管理的多方面性质，强调优化患者预后方面的挑战和不断发展的策略。
