Surgery presents unique challenges in pain management for patients with chronic pain. A perioperative optimization program, starting at decision to surgery, is likely to yield the best results for this population. Perioperative optimization focuses on psychological, medical, and physical optimization. Psychological optimization includes cognitive behavior therapy, relaxation, and music therapy. Medical optimization focuses on the multimodal approaches of pharmacological adjustment and physical optimization focuses on prehabilitation and nutrition optimization. The ideal care model incorporates these optimization strategies into clinical practice to prepare the patient appropriately for the best possible outcomes. Although preoperative optimization is key for sustained outcomes, intraoperative and inpatient protocols are equally important, as is postdischarge subacute support by pain specialists, as needed, for up to 90 days after surgery.