How Hospitals Are Helping Patients Manage Pain With Fewer Opioids

How Hospitals Are Helping Patients Manage Pain With Fewer Opioids

Publication date: Feb 13, 2020

But as he and Campbell discussed how much pain he might feel after the surgery and how they’d manage it without an emphasis on opioids, he realized that it could happen to anyone – even him.

In a study of 68 patients who had surgery to repair torn meniscus cartilage in the knee, Campbell and colleagues -found no significant difference in pain control, satisfaction, and total 1-week opioid use” between patients prescribed 30 to 40 tablets of combo oxycodone-plus-acetaminophen pills and those with prescriptions for just 10 combo pills and a nonaddictive ibuprofen regime.

-All patients used only limited amounts of opioids to control postoperative pain, suggesting we are currently overprescribing opioids,” the researchers concluded.

Dr. Charla Fischer, a spine surgery expert and colleague of Campbell’s at NYU Langone’s orthopedics department (and no relation to Dane Fischer), said that most of the time when a person becomes addicted to opioids, it’s not a result of their own medical treatments.

It’s no longer standard practice at NYU Langone orthopedics to give patients opioid refills without seeing them first, which gives the doctors a chance to figure out why they’re asking for more – whether it’s due to ongoing pain or because a patient is becoming dependent, and whether a treatment other than painkillers can help.

In early 2018, he spearheaded a 1,600-patient pilot program at the Cleveland Clinic’s Fairview Hospital, where doctors deliver over 5,000 babies a year, to test the impact on pain management of reducing the amount of opioids cesarean section patients received.

Patients in the pilot program got no opioid painkiller during surgery, and afterward received the maximum dose of Tylenol every six hours, along with some ibuprofen.

By mid-2019, C-section patients who did use opioids were discharged with around 12 pills, and by the end of the year that number was down to three to five pills.

If a patient hasn’t received opioids in the hospital, she’s sent home with no opioid prescription at all.

Nationally, around 6% of patients who are exposed to opioids for the first time during surgery become long-term users later on.

The Cleveland Clinic has now implemented the new C-section protocol across its entire system, and is now working to reduce opioids across all surgeries.

During an initial study involving 100 patients, Hedrick and colleagues soon discovered that it was possible to cut opioid consumption by 80% in favor of nonaddictive alternatives, without increasing patients’ discomfort.

According to a 2019 analysis of Medicare data by the Johns Hopkins School of Public Health and Kaiser Health News, from 2011 through 2016, thousands of surgeons sent patients home with prescriptions for dozens of opioid pills, sometimes more than 100, even for surgeries unlikely to cause much postoperative pain.

-Not only with C-sections, but with all surgeries, we’re treating with too much opioid pain medicine, and discharging with too much opioid pain medicine,” Chiang said.

Concepts Keywords
Acetaminophen Psychoactive drugs
ACL RTT
ACL Injury Opioids
Acupuncture Euphoriants
Advil Perception
Anesthesiologist Morphine
Anterior Cruciate Ligament Morphinans
Athletics Opioid epidemic
Bowel Oxycodone
Breakthrough Pain Pain management
Campbells Analgesic
Cartilage C section protocol
Cleveland Years protocols
Cleveland Clinic Opioid protocols
Colorectal Surgeon Shoulder surgery
Colorectal Surgery Colorectal surgery
Disclosure Acupuncture
Fairview Knee surgery
Fairview Hospital Breathing exercises
Fitness Spine surgery
Gynecology Pain management
Holistic Surgeries
Hospital Cut
Ibuprofen Nausea
Medicare Postnatal depression
Meniscus Section protocol
Narcotics Opioid protocols
Nausea Years protocols
Nonsteroidal Opioid protocol
NYU
Obstetrics
Opioid
Opioid Addiction
Opioid Epidemic
Opioids
Orthopedic
Orthopedic Surgeon
Orthopedics
Oxycodone
Pain
Pain Management
Pain Medicine
Painkiller
Painkillers
Park
Percocet
Pickup
Pop
Postnatal Depression
Protocol
Soccer
Substance Abuse
Tablets
The Cleveland Clinic
The Standard
Torn ACL
Trainer
Tylenol
United States
UVA
Virginia

Semantics

Type Source Name
disease MESH habit
disease MESH communities
disease MESH opioid addiction
drug DRUGBANK Oxycodone
drug DRUGBANK Acetaminophen
drug DRUGBANK Ibuprofen
disease MESH satisfaction
drug DRUGBANK Tropicamide
drug DRUGBANK Etodolac
disease MESH infections
disease MESH postnatal depression
disease MESH complications
disease MESH substance abuse

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