Mechanism-Based Perioperative Pain Modulation Strategies in Spine-Related Disorders
DOI:
https://doi.org/10.64784/107Palabras clave:
Spine-related pain, perioperative anesthesiology, pain modulation, multimodal analgesia, regional anesthesia, central sensitization, chronic pain prevention, opioid-sparing strategies, neuromodulationResumen
Pain associated with spine-related disorders represents a major clinical and perioperative challenge due to its multifactorial nature and its tendency to persist beyond the immediate surgical period. Contemporary evidence indicates that pain in this context arises from the interaction of nociceptive, neuropathic, and centrally mediated mechanisms, with central sensitization playing a key role in pain amplification and chronicity. This narrative review synthesizes current evidence on perioperative and long-term anesthesiology strategies for pain modulation in spine-related disorders, integrating insights from pain neurobiology, multimodal analgesia, regional anesthesia, pharmacologic adjuncts, and interventional pain management. The findings highlight multimodal analgesia as a cornerstone of perioperative care, consistently associated with opioid-sparing effects and context-dependent improvements in analgesic efficacy and recovery-related outcomes. Regional and interfascial plane techniques are identified as valuable components within multimodal pathways, offering trade-offs between analgesic coverage, feasibility, and physiologic stability. Adjunct pharmacologic strategies demonstrate mechanism-specific benefits that support individualized selection based on pain phenotype. Importantly, the review emphasizes pain modulation as a continuum of care, extending from preoperative risk identification to long-term follow-up and escalation strategies for persistent or refractory pain. From an international perspective, the principles discussed are adaptable to diverse healthcare systems, including those in Latin America. Overall, the evidence supports a shift toward coordinated, mechanism-based, and longitudinal anesthesiology strategies to optimize outcomes in patients with spine-related pain.
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