Once a person has become dependent on opioid painkillers, it's too late to be truly proactive about the problem. Providers must start planning how to help patients avoid addiction before they need opioid painkillers—before the surgery, before the procedure, before the patient is even in pain.
Preoperative plans are the way to go, according to an article published in the Journal of Pain in 2016. Making plans in advance gives clinicians the chance to consider all the possibilities and also allows for preoperative education of the patient, so s/he knows what to expect. Ideally, the plan will include an assessment of the patient and his or her individual needs, along with the specific surgical procedure. For example, an older, sedentary patient undergoing one type of surgery may have different pain management needs than a younger, more active patient undergoing a different procedure—or even the same procedure.
The value of planning out a multimodal approach
Those preoperative pain management plans should also consider the many possible ways to help a patient manage pain. For example, a multimodal pain management plan could use more than one method of pain management. This could include drugs from two different classes—i.e., medications that act along different pathways to reduce the pain that the patient experiences.
A multimodal pain management plan could also include a drug coupled with one or more non-pharmacological treatments. Those non-pharmacological options could be heat or cold therapy, massage, or various types of cognitive behavioral therapies. Some healthcare teams might even be open to considering complementary therapies such as acupuncture.
That's not to say that these plans will always exclude the use of opioids. In fact, a clinician could decide that it's appropriate to deploy a multimodal plan that incorporates the use of an opioid along with other therapies. The key point is that when possible, the plan should not rely solely (or mainly) on an opioid to provide relief for the patient. Of course, this will hinge on the severity of pain that the patient experiences; it may be more appropriate to limit the non-pharmacological therapy for a patient with very severe acute pain, for example.
Because they incorporate multiple therapies to address pain, multimodal treatment regimens can minimize the need for opioids (or reduce the dose amount), which, in turn, may reduce the likelihood that a patient becomes dependent on opioids for relief. And, because using two different types of drugs together can reduce the overall opioid dose, it can also reduce unpleasant opioid-related side effects.
Need more guidance?
Fortunately, there are options available to help providers figure out the best way to deploy the optimal pain-management plans for their patients, including preoperative plans.
The Joint Commission accredits and certifies nearly 21,000 healthcare organizations and programs in the United States. They recently released a report to help providers better understand and comply with pain-management standards. The R3 Report: Requirement, Rationale, Reference is designed to help hospitals learn more about the standards that The Joint Commission expects them to meet. Organizations are now expected to make safe opioid prescribing an organizational priority and find ways to meet their patients' needs while minimizing the risks associated with their treatment.
Additionally, eviCore's suite of evidence-based solutions can guide healthcare teams in determining the most effective ways to help patients manage pain (including chronic pain)—without incurring the risk of opioid addiction. For example, the eviCore Musculoskeletal solution could be particularly helpful to providers working with patients suffering from back pain, which, as the American Academy of Pain Medicine notes, is the most common type of chronic pain suffered in the U.S.