Postoperative pain and surgical recovery: are we treating pain or building resilience?

Postoperative recovery remains highly variable despite advances in surgical techniques and perioperative care. Contemporary strategies, including Enhanced Recovery After Surgery (ERAS) protocols and multimodal analgesia, have improved outcomes but do not fully explain interindividual differences in recovery trajectories. Current perioperative models emphasize stress attenuation and symptom control but insufficiently address the mechanisms underlying the transition from acute postoperative pain to chronic pain and long-term disability. Surgical resilience is conceptualized as a dynamic, multidimensional adaptive process reflecting the patient's capacity to maintain or regain functional, psychological, and physiological equilibrium in response to surgical stress over time. Rather than a fixed trait, it emerges from the interaction between biological reserve, psychological adaptability, and behavioral engagement, modulated by contextual factors such as social support and access to care. Within this context, postoperative pain is not merely a symptom but a modifiable factor influencing recovery through physiological and behavioral mechanisms. In this perspective article, we emphasize the implementation of a multidimensional model integrating biological, psychological, behavioral, and clinical domains, in which pain management acts as a central modulator of recovery trajectories. This perspective highlights a critical gap in perioperative research and supports the transition toward personalized, resilience-oriented strategies.