More than a Band-Aid on a Bullet Wound
An Anesthesiologist’s Role in Innovative Pain Management Techniques
The Current State of Our Opioid Epidemic
In 2017, the U.S. Department of Health and Human Services declared a public health emergency to address the nation’s opioid crisis. Opioid overdoses accounted for more than 42,000 deaths in 2016, averaging 116 deaths every day, more than any previous year on record. An estimated 40% of opioid overdose deaths involved a prescription opioid and 11.5 million people misused prescription opioids. Globally, heroin remains the most commonly used opiate, consumed by a vast majority (about 75%) of an international opiate-user population. Devastating consequences of the opioid epidemic include opioid misuse, overdoses and newborns experiencing withdrawal syndrome.
The Opioid Epidemic Presents a Wide Array of Challenges to an Anesthesiologist
Opioid addiction presents unique challenges to patients and their anesthesia team. Emergency surgery or urgent invasive procedures may have to proceed without full knowledge of a patient’s medical history. Patients having elective surgery may either be known or unknown chronic opioid users and on various maintenance regimens like methadone or suboxone. Further, patients suffering from chronic pain often require repeated surgeries, which presents them with the additional challenges of tolerance and addiction in the perioperative period. For those patients in recovery from addiction, surgery and pain management with opioids may trigger a relapse. Perhaps most disturbing, fully one in 14 people undergoing elective surgery, who have never before taken opioids for any reason, are still taking opioids regularly one year later. These are complex concerns since the majority of patients will require pain medication at some point in the perioperative or post-discharge period.
Still, pain relief after surgery is an important part of a patient’s recovery process. Surgical anesthesia and postoperative care should be designed to minimize pain and suffering and decrease the likelihood of opioid dependence.
PhyMed Healthcare Group is Dedicated to Implementing Innovative Pain Management and Addiction Programs
Effective pain management can also impact value-based care and reimbursement. Value-based care means returning patients to their lives at the lowest overall cost in terms of convenience, expense and discomfort. Comfortable patients enjoy shorter stays in the hospital and recover faster with fewer complications. Hospitals and physicians are required to report patient satisfaction scores (including scores for pain relief) as part of the Merit-Based Incentive Payment System (MIPS), a government program tied to provider reimbursements.
But here is the rub. Reliance on opioids for pain relief often causes nausea, constipation and results in longer hospital stays. An over-reliance on opioids can lead to tolerance, habituation and addiction. What is designed to help improve outcomes (pain relief) threatens to delay a return to normal life at an enormous cost in terms of patient convenience, total expense for care and discomfort.
At PhyMed Healthcare Group, the anesthesia care team plays a key role in working toward a solution to the opioid epidemic by implementing innovative pain management programs.
The ON-Q Pain Relief System is a postoperative, non-narcotic pain relief system designed to deliver local anesthetic at or near the surgical site through specially designed catheters. Not only does this system provide patients days of targeted pain relief after surgery, it also delivers:
- Better pain relief, while reducing narcotic side effects, such as: nausea, vomiting, constipation and grogginess
- Less need for narcotics
- A quicker return to normal body function
- Feeling better faster
- Greater mobility
- Potential for earlier hospital release
Innovative systems like the ON-Q Pain Relief System, “single shot” nerve blocks and multimodal analgesic regimens all fit together in a collaborative approach to improve pain control while lessening the adverse effects of opioids.
Communication is key to integrating the innovative techniques into a perioperative plan that will minimize the potential for opioid tolerance and addiction. PhyMed collaborates with the surgical team to minimize these risks and works to ensure that patients have a strong support system. This can include finding community resources and discussing risks with patients, caregivers and family members.
Together, PhyMed is working to provide our anesthesiologists, CRNAs and patients the best tools to effectively manage pain while ensuring that patients can return to their normal lives quickly, and at the lowest overall cost in terms of convenience, expense and discomfort.