It’s a challenging time to work in pain management: An opioid abuse and addiction epidemic continues to roil the nation. In Florida, new laws governing the dispensing of controlled substances, including ones used to treat acute pain, took effect on July 1. Meanwhile, physicians want the safest, most effective pain control for their patients.
At UF Health Shands, a long-standing Pain Management Committee comprises a cadre of physicians, nurses, pharmacists and quality assurance professionals. They meet regularly to discuss and solve pain management issues affecting children and adult patients. As pain management has evolved, so has the committee’s focus. Today, our experts say pain management is much more customized and patient-specific.
“The focus has really narrowed on administering doses that are consistent with the type and degree of pain a patient is experiencing,” said Robert Nappo, D.N.P., ARNP, UF Health Shands Perioperative Services associate vice president.
Amy Rosenberg, Pharm.D., BCPS, UF Health Shands Hospital pharmacy specialist in medication safety and quality, has seen pain management come full circle since early in her pharmacy career, when pain management practice embraced more liberal use of medications.
“Now, it’s really kind of the opposite from a medication selection perspective,” she said. “We’re trying to minimize use of the opioid class of medications when and where we can.”
That can mean trying new strategies such as multimodal analgesia — an approach that emphasizes several different interventions to avoid or limit the need for opioid medications, said Rene Przkora, M.D., Ph.D., chief of pain medicine and an associate professor of anesthesiology in the UF College of Medicine.
Multimodal analgesia improves pain control by using interventions that act on different pain mechanisms. These include non-opioid medications, nerve ablation and steroid injections as well as advanced interventions such as spinal cord stimulation. The result can be effective, individualized pain management without the potential risks and side effects of opioids.
UF Health Shands is also a leader in using continuous local anesthetic infusion, which provides pain control to a specific part of the body, such as a surgical site. It delivers effective, localized pain control without opioids, Przkora said.
There’s also a renewed emphasis on adjunct treatments that don’t involve medications — hot compresses, cold packs and elevating and repositioning patients. The Pain Committee has begun monitoring and encouraging these non-medication pain interventions.
“Some things we used to think of as commonsense,” Rosenberg said. “We’re focusing more on them as pain management interventions.”
Based on a patient’s needs, pain specialists use additional disciplines such as physical therapy and psychology, Przkora said. Because pain can lead to a host of issues, such as poor job performance or relationship troubles, he said it’s important to have a holistic approach.
Whether it’s a single drug or broader pain management issues, the committee’s focus is the same: personalized patient care to help ensure safe and effective treatment.
Przkora added, “It’s not just about a pain score and/or dose of morphine, it is about the patient.”