CPA: Where do you believe the future of pain management is going?
ERA: The world of pain medicine is becoming subspecialized. Unlike chronic pain conditions which may be amenable to palliation, “acute” pain (new onset, often with an identifiable cause) requires a different and often more aggressive approach. This requires development of a system led by physicians dedicated to understanding and treating acute pain pathophysiology and investigating new ways to treat it. Acute pain medicine involves the routine use of multiple modalities concurrently (i.e., multimodal analgesia) in the in-hospital setting to reduce the intensity of acute pain and minimize the development of debilitating persistent pain, a problem that can result from even common surgical procedures or trauma and acute illness. Unfortunately, the need for specialists in acute pain medicine is increasing. Fortunately, the number of clinical fellowship programs in regional anesthesiology and acute pain medicine (requiring one extra year of postgraduate training after anesthesiology residency completion) has grown to over 60, and these programs will soon be able to apply for accreditation through the Accreditation Council for Graduate Medical Education.
Given the great influence that pain management can have on the inpatient experience as measured by the HCAHPS survey, hospitals will need to invest in physician leaders who can run acute pain medicine teams and design systems to provide individualized, comprehensive, and timely pain management for both medical and surgical patients in the hospital, to expeditiously manage requests for assistance when pain intensity exceeds acceptable levels, and to prevent acute pain intensity from reaching levels that may result in the persistent pain syndromes.
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