Surgical Pain Management in the Setting of Opioid Tolerance and Misuse


Patients who take opioids chronically, for conditions other than surgery, or who have opioid use disorder require tailored, individualized pain management strategies. Surgeons often have little-no guidelines, knowledge, and lack experience and comfort in managing these patients. This course will teach participants how to screen for opioid use pre-operatively, set patient expectations regarding pain management prior to surgery, and increase familiarity with naltrexone, buprenorphine and methadone dosing and how additional, short-term opioids at larger than normal doses may be required to mitigate postoperative pain.

Surgical professionals will also learn how and when to communicate with opioid treatment programs as well as utilize ERAS protocols and environmental strategies to minimize pain and reduce long-term opioid use in these patient populations. The ACS patient education guide with a functional scale and Safe Pain Control video are also included as part of this training course.

This course may be taken as part of the MATE act and may satisfy the regulatory mandate of opioid/pain management.


Picture of Surgical Pain Management in the Setting of Opioid Tolerance and Misuse
  • $25.00

About this course

Faculty Credentials

Disclosure Information

In accordance with the ACCME Accreditation Criteria, the American College of Surgeons must ensure that anyone in a position to control the content of the educational activity (planners and speakers/authors/discussants/moderators) has disclosed all financial relationships with any commercial interest (termed by the ACCME as “ineligible companies”, defined below) held in the last 24 months (see below for definitions). Please note that first authors were required to collect and submit disclosure information on behalf all other authors/contributors, if applicable.

Ineligible company

The ACCME defines an “ineligible company” as any entity producing, marketing, re-selling, or distributing health care goods or services used on or consumed by patients. Providers of clinical services directly to patients are NOT included in this definition.

Financial Relationships

Relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit.  Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received, or expected. 

Conflict of Interest

Circumstances create a conflict of interest when an individual has an opportunity to affect CME content about products or services of an ineligible company with which he/she has a financial relationship.

The ACCME also requires that ACS manage any reported conflict and eliminate the potential for bias during the educational activity.  Any conflicts noted below have been managed to our satisfaction. The disclosure information is intended to identify any commercial relationships and allow learners to form their own judgments. However, if you perceive a bias during the educational activity, please report it on the evaluation.  


Faculty Disclosures

Ana Berlin, MD, FACS - Nothing to disclose 
Melissa Red Hoffman, MD, FACS - Nothing to disclose 
Tonia Young-Fadok, MD, FACS - Nothing to disclose
John A. Harvin, MD, FACS - Nothing to disclose
Jonah J. Stulberg, Md, PhD, MPH, FACS - Nothing to disclose
Bridget Fahy, MD, FACS - Nothing to disclose



Learning Objectives

  • Screen for chronic pain and opioid tolerance and integrate medical reconciliations into a safe pain management plan for patients.
  • Better manage perioperative pain in patients who take chronic opioids or those on medication-assisted treatment by using both pharmacologic and non-pharmacologic adjuncts and by adjusting short-acting opioid doses to account for opioid tolerance.
  • Outline the diagnostic criteria for opioid use disorder (OUD) as well as explain how buprenorphine and methadone are used to manage OUD.
  • Describe strategies for patients and caregivers including expectation management to promote safe and effective management of pain related to surgical illnesses in patients with opioid tolerance or elevated risk of opioid misuse.
  • Explain how team training can help minimize postoperative pain.
  • Identify ERAS components that can help minimize patient pain and anxiety along the surgical continuum (ie, pre-op, post-op/recovery).



  • For questions about the educational activity, please contact Kathleen Maruyama at

Target Audience

This activity is intended for surgeons and members of the surgical team (preoperative, intraoperative, and postoperative).

CME Accreditation

Continuing Medical Education Credit Information


The American College of Surgeons is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

AMA PRA Category 1 Credits™

The American College of Surgeons designates this enduring activity for a maximum of 2.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Of the AMA PRA Category 1 Credits™ listed above, a maximum of 2.00 credits meet the requirements for Self-Assessment.


American College of Surgeons and ACGME Logos

CME Credit Claiming Information

In order to claim a CME Certificate or a Certificate of Completion, the following requirements will need to be completed in the course:

  • Review all course materials
  • Complete the post test
  • Course evaluation

Participants may only claim a maximum of 2.00 AMA PRA Category 1 Credits™ for this activity.