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Seventy-Two–Hour Postoperative Pain Severity in Opioid-Using and Opioid-Naïve Patients.

Increased perceived postoperative pain severity as measured with a visual analog scale (0 = no pain and 10 = severe pain; mean, SD) in patients with chronic pain on opioid therapy vs opioid-naïve patients without chronic pain.

Analgesic Doses Taken During the First 72 Hours Postoperatively in Opioid-Using and Opioid-Naïve Patients.

Patients with chronic pain on opioid therapy used more analgesics (mean, SD) during the first 72 hours postoperatively vs opioid-naïve patients without chronic pain.

Molecular structures of morphine, codeine, and derivatives. Codeine and its derivatives differ from their morphine-derived counterparts only in a methyl substitution (circled). This methyl group prevents adequate binding to the mu opioid receptor that mediates most opioid effects. However, these prodrugs are capable of producing nausea and constipation, which are problematic when high doses are administered to generate enough active metabolite for analgesia. (Asterisks indicate molecular alterations from morphine and codeine.)

(a) Cold-Pressor and (b) Heat Pain Tolerance and Severity in Opioid-Using and Ppioid-Naïve Patients.

Decreased pain tolerance and increased perceived pain severity (mean, SD) in patients with chronic pain on opioid therapy vs opioid-naïve patients without chronic pain across cold-pressor and heat pain assays.