Must Reads

Rethinking Pain Management: 4 Options to Consider Articles PPAHS has been reading

Editor’s note: As the opioid epidemic rages on, we need to rethink how pain is managed. Guidelines aimed at reducing the number of opioids prescribed has had an unintended consequence.

As the opioid epidemic rages on, we need to rethink how pain is managed. Guidelines aimed at reducing the number of opioids prescribed has had an unintended consequence. In the article, “Good News: Opioid Prescribing Fell. The Bad? Pain Patients Suffer, Doctors Say,” the NY Times reports:

… in a letter to be sent to the Centers for Disease Control and Prevention on Wednesday, more than 300 medical experts, including three former White House drug czars, contend that the guidelines are harming one group of vulnerable patients: those with severe chronic pain, who may have been taking high doses of opioids for years without becoming addicted. They say the guidelines are being used as cover by insurers to deny reimbursement and by doctors to turn patients away. As a result, they say, patients who could benefit from the medications are being thrown into withdrawal and suffering renewed pain and a diminished quality of life, even to the point of suicide.”

Source: https://commons.wikimedia.org/wiki/File:Children%27s_pain_scale.JPG

We have been reading about some interesting new studies about how to better manage pain. Here are 5 to consider:

#1 – Use ‘Pain Balls’

Recovering from a C-Section can be painful. Van Reid Bohman MD, FACOG (Desert Perinatal Associates) has been using “pain balls.”

The pain ball delivers a non-addictive, numbing anesthetic through a catheter directly to surgical incisions. It’s one of a number of opioid alternatives being used to help woman who have had a C-sections deal with post-surgery pain.

#2 – Develop a Cross-Functional Response

NYU Langone Health’s department of orthopedic surgery led an institution-wide effort to rethink and reduce the use of opioids in patient care for subspecialty procedures, to make more common procedures opioid-free or opioid-light.

“NYU Langone orthopedic surgeons have collaborated closely with other hospital stakeholders, including anesthesia, pain management, pharmacy and healthcare IT, to develop a cross-functional response to the opioid epidemic,” says Joseph A. Bosco, MD, professor of orthopedic surgery and vice chair of clinical affairs at NYU Langone, and second vice president of the American Academy of Orthopaedic Surgeons.

#3 – Use Point-of-Care Ultrasound (POCUS)

Researchers at the School of Biological and Health Systems Engineering at Arizona State University tested the feasibility of a point-of-care ultrasound (POCUS) neuromodulation device in patients suffering from carpal tunnel syndrome or cervical radiculopathy.

The researchers saw improved outcomes, including reduced nerve inflammation, restored function and diminished pain.

#4 – Employ a Multimodal Analgesic Approach

Researchers at at Mount Sinai Hospital, in Chicago used a multimodal analgesic approach to post–cesarean delivery pain management. They found that using this approach decreased the number of opioid tablets prescribed at discharge by 52%, according to a retrospective chart review presented at PAINWeek 2018.

The multimodal approach consisted of analgesics with various mechanisms of action for an additive or synergistic effect in order to minimize opioid use.

 

Patient Safety

A New Take on Managing Pain

In this guest post, Dr. Aliza Weinrib advocates for a new take on managing pain.

By Dr. Aliza Weinrib Clinical Psychologist, University Health Network

We have all been there. That moment when your doctor asks you, “So… how has your pain been since I’ve seen you last?”

At that moment, you turn to your memory to provide you with a summary of all the ups and downs that you have been through. Of course, you remember your pain! Your pain is very hard to forget or ignore!

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Patient Safety

5 Key Recommendations for Safe Procedural Sedation Position Statement on Patient Monitoring During Procedural Sedation

The Physician-Patient Alliance for Health & Safety is pleased to release the Position Statement on Procedural Sedation.

The number of noninvasive and minimally invasive procedures performed outside of the operating room has grown exponentially over the last several decades. Depending on the patient and the medical procedure, many of these are performed under sedation to manage the patient’s pain and/or anxiety without inducing general anesthesia.

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Opioid Safety

Do These 3 Efforts Help Stop the Opioid Epidemic? Articles PPAHS have been reading the week of June 25, 2018

Articles the Physician-Patient Alliance for Health & Safety (PPAHS) have been reading the week of June 25, 2018 focus on 3 efforts to help stop the opioid epidemic.

Effort #1 – Does Government Legislation Address the Opioid Epidemic?

The House of Representatives recently passed what has been called the “most expansive legislation” to address the opioid epidemic. According to CNN, the key provision would allow Medicaid to pay for certain treatments for mental illness.

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Opioid Safety, Respiratory Compromise

Use of PCA Safety Checklist Found to Reduce Pain 1 out of every 378 are harmed by PCA

Researchers at the University of Colorado Hospital recently reported that their use of a PCA safety checklist was found to reduce pain from moderate-severe pain to no-mild pain in 42% of patients within 2 days. In “Let’s Be Smart About Improving Pain,” they reported:

Our PCA safety checklist smart phrases increased use of a safety checklist and documentation of daily PCA opioid trends, and correlated with more rapid improvement in moderate-severe pain levels.

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Opioid Safety, Practices & Tips, Respiratory Compromise

3 Tips for Managing Pain and Using Opioids Safely Articles the PPAHS team has been reading the week of January 15, 2018

From the articles we have been reading this week, here are 3 tips for managing pain and using opioids safely.

#1 Tip for Managing Pain and Using Opioids Safely – Premier Safety Institute new toolkit helps providers manage pain, curb opioid use

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Opioid Safety, Patient Safety, Respiratory Compromise

We Need to Focus on Patient Safety to Battle the Opioid Epidemic: 5 Key Steps to a More Balanced Approach

Though much of the attention to end the opioid epidemic is centered on the improper use of opioids in the community (misuse, diversion, etc), the truth is that opioid harm exists across a continuum of care. The safe use of opioids begins with the safe use of opioid analgesics in the hospital setting and the prescription of opioids upon discharge of the patient from a healthcare facility. We must first and foremost make sure that opioids provided to patients are done so in a safe manner both during administration and upon discharge.

By Michael Wong, JD (Founder and Executive Director, Physician-Patient Alliance for Health & Safety)

Opioid-related deaths are a leading national and community concern. Unfortunately, reports of opioid-related deaths occur with astonishing regularity in our daily news feeds.

Though much of the attention on opioid-related harm is centered on the improper use of opioids in the community (misuse, diversion, etc), the truth is that opioid harm exists across a continuum of care. The safe use of opioids begins with the safe use of opioid analgesics in the hospital setting and the prescription of opioids upon discharge of the patient from a healthcare facility. We must first and foremost make sure that opioids provided to patients are done so in a safe manner both during administration and upon discharge. Read More

Opioid Safety, Patient Safety, Patient Stories

Are Patients Receiving Opioids Safer Today Than 6 Years Ago?

Six years ago on July 27, 2011, I posted the first article on a free Wordpress blog for the Physician-Patient Alliance for Health & Safety. It was titled “Is it possible to survive 96-minutes without a heart beat?”. Howard Snitzer, a man who suffered a heart attack survived after two volunteer paramedics responded and began a 96-minute CPR marathon. The ordeal involved 20 others, who took turns pumping his chest. This life-saving feat was only possible with the use of capnography readings, which told the volunteer paramedics that Howard was still alive and that they needed to continue their efforts.

Little would I know that that article would lead to an invitation by the University of Notre Dame and the beginnings of a 6-year friendship with the parents of Amanda Abbiehl. Amanda was admitted to hospital for “severe strep throat.” Read More

Opioid Safety, Patient Stories, Practices & Tips, Respiratory Compromise

The Preventable Death of Paul Buisson: 3 Lessons on Preventing Opioid Death

The following is an excerpt of an article first published on The Doctor Weighs In on June 28, 2017. To read the full article, please click here.

In 2005, Paul Buisson, a celebrated Quebec animator and cameraman died as a result of opioid-related respiratory depression. What lessons can we learn more than a decade later? Read More