Postoperative Pain Treatments: Intensive Care, First Aid, Alternative Medicine, Acupuncture (Part 4)

Abstract

Comprehensive surgical care is a growing global health priority, yet postoperative pain remains undertreated and contributes to complications, prolonged recovery, persistent opioid use, and chronic postsurgical pain. To synthesize current evidence on perioperative and postoperative pain management strategies, with emphasis on multimodal analgesia, intensive care considerations, and the potential role of acupuncture as an adjunctive non-pharmacological intervention. A narrative literature review was conducted using keywords related to intensive care, first-line analgesia, multimodal strategies, and acupuncture. Sources included clinical guidelines, systematic reviews, and observational studies addressing adult surgical populations, including high-risk groups and low- and middle-income settings. Postoperative pain is multifactorial, involving peripheral and central sensitization, and is influenced by biological, psychological, and social factors. Multimodal analgesia, combining non-opioid analgesics, regional techniques, adjuvants, and opioids as rescue therapy, improves analgesic efficacy, reduces opioid requirements, and lowers adverse event rates. In surgical intensive care units, protocolized pain and sedation assessment shortens length of stay and improves functional outcomes, whereas undertreated acute pain increases the risk of chronic pain and reduced quality of life after discharge. Opioids remain necessary for severe pain but should be used at the lowest effective dose and duration, with systematic safety monitoring. Acupuncture and related stimulation techniques may reduce postoperative pain, nausea, and vomiting with minimal side effects, supporting their integration into multimodal regimens when delivered by trained practitioners. Early pain assessment, risk stratification, individualized analgesic planning, and clinical pharmacist involvement are key to optimizing safety and outcomes. Contemporary postoperative pain management should be viewed as a continuous, evidence-based process spanning preoperative assessment to post-discharge recovery. Implementing multimodal, patient-centered strategies, strengthening interdisciplinary collaboration, and incorporating validated non-pharmacological options such as acupuncture can enhance analgesic quality, support functional rehabilitation, and reduce the burden of postsurgical pain.