This learning activity examines the perioperative management of chronic pain patients in the ambulatory surgery center (ASC) setting, where compressed timelines and standardized workflows can complicate care for patients with elevated baseline pain, opioid tolerance, or central sensitization. It reviews evidence-based preoperative assessment tools, including the PEG scale and screening for pain catastrophizing, alongside multimodal and non-pharmacologic strategies designed to reduce opioid reliance while maintaining safe, timely discharge. Special attention is given to acute-on-chronic pain, including current guidance on managing patients maintained on chronic opioids or buprenorphine-based medication-assisted treatment (MAT), equipping nurses to recognize and respond to the unique clinical and psychosocial needs of this growing patient population.