Enhanced recovery pathways for patients with chronic pain: beyond standard protocols – a narrative review

PURPOSE OF THE REVIEW: Patients with chronic pain commonly present for surgery and may experience more complex perioperative recovery. This review summarizes how enhanced recovery pathways [including enhanced recovery after surgery (ERAS)] may be adapted to better support this high-risk population. RECENT FINDINGS: Recent literature highlights the importance of preoperative identification of chronic pain, opioid exposure, psychological comorbidity, and functional limitation. These factors may increase the risk of severe postoperative pain, prolonged opioid use, delayed recovery, and chronic postsurgical pain. Multimodal analgesia, opioid-sparing strategies, multidisciplinary care, and recovery-focused follow-up are central to chronic pain-adapted ERAS care. SUMMARY: Standard ERAS pathways remain highly relevant but may not fully address the needs of patients with chronic pain. A more personalized approach incorporating early risk stratification, tailored analgesic planning, opioid stewardship, and functional recovery goals may improve short- and long-term outcomes.