PPPD Treatment
I cannot provide evidence-based recommendations for Post-Procedural Pain Disorder (PPPD) treatment because the provided evidence exclusively addresses procedure-related acute pain and post-surgical pain management in cancer and surgical contexts, not the vestibular disorder known as Persistent Postural-Perceptual Dizziness (PPPD).
Critical Clarification Needed
The evidence base provided discusses:
- Procedure-related pain management in cancer patients 1
- Post-pancreatectomy pain management 2
- Perioperative pain protocols 3, 4, 5
- Post-flight care after sedation 6
- Persistent postsurgical pain prevention 7, 8
None of these sources address PPPD as a vestibular disorder, which is characterized by chronic dizziness, unsteadiness, and non-spinning vertigo triggered by upright posture, motion, or complex visual stimuli.
If You Meant Persistent Postsurgical Pain
If your question concerns persistent pain after a surgical procedure rather than the vestibular condition:
Multimodal analgesia combining non-opioid medications with minimal opioid use represents the evidence-based standard for managing persistent postsurgical pain. 4, 8
Initial Management Approach
- Acetaminophen (1g scheduled) should be administered as first-line therapy for all patients unless contraindicated 3, 4
- NSAIDs or COX-2 inhibitors should be added around-the-clock if no renal, cardiovascular, or bleeding contraindications exist 2, 4
- Gabapentinoids (gabapentin or pregabalin) should be initiated for neuropathic pain components, which occur in approximately 70% of persistent postsurgical pain cases 2, 7
Opioid Management Strategy
- Transition from strong to weak opioids or discontinue entirely within 2-4 weeks post-procedure, as only 6% of patients require strong opioids beyond the acute phase 7
- Immediate-release opioid formulations (10-20% of 24-hour requirement) should be available for breakthrough pain only, not scheduled 1, 2
- Prophylactic laxatives must be prescribed with any opioid use to prevent constipation 2, 3
Specialized Interventions
- Outpatient pain clinic referral should occur within 2 months if pain persists despite multimodal therapy, as early intervention prevents chronification 7
- Physical therapy and psychological support should be integrated for patients with multiple risk factors (young age, female gender, pre-existing chronic pain, psychological vulnerability) 7, 8
Please clarify whether you are asking about the vestibular disorder PPPD or persistent postsurgical pain so I can provide the appropriate evidence-based guidance.