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.

 

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, Respiratory Compromise

The Problem of Pain

By Kenny Lin, MD, MPH

My patients lie to me every day. Some tell me that they have been taking their medications regularly when they haven’t. Some say that they have been eating a healthy diet and exercising for at least 30 minutes every day and don’t know where the extra pounds are coming from. Some lie that they are using condoms every time they have sex, that they have quit smoking, and if they drink alcohol at all, it’s only a single glass of wine with dinner. They bend the truth for many reasons: because they want to please their doctor, because they don’t like to admit lapses of willpower, or because they are embarrassed to tell me that they can’t afford to pay for their medications. I forgive them; it’s part of my job to understand that patients (and health professionals) are only human. The only lies that I find hard to forgive are the lies about pain. Read More