The Refill: How Anesthesiologists, Pain Medicine Specialists Can Demonstrate Value — Part 2

CPA: How has your opioid prescribing habits changed?

ERA: In the past, pain management for patients have surgery was limited to the use of opioids (narcotics). Opioids only attack pain in one way, and just adding more opioids does not usually lead to better pain control. In 2012, the American Society of Anesthesiologists (ASA) published its guidelines for acute pain management in the perioperative setting. This document recommends “multimodal analgesia” which means that two or more classes of pain medications or therapies, working with different mechanisms of action, should be used in the treatment of acute pain.While opioids are still important pain medications, they should be combined with other classes of medications known to help relieve postoperative pain unless contraindicated.

These include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs): Examples include ibuprofen, diclofenac, ketorolac, celecoxib. NSAIDs act on the prostaglandin system peripherally and work to decrease inflammation.
  • Acetaminophen: Acetaminophen acts on central prostaglandin synthesis and provides pain relief through multiple mechanisms.
  • Gabapentinoids: Examples include gabapentin and pregabalin. These medications are membrane stabilizers that essentially decrease nerve firing.

The ASA also strongly recommends the use of regional analgesic (nerve block, spinal, or epidural) techniques as part of the multimodal analgesic protocol when indicated..

CPA: Do you believe that Medicare and workers compensation guidelines are truly in the best interest of the patient?

Since I work in acute pain medicine and anesthesiology at a VA hospital, I am somewhat insulated from issues related to Workers Compensation and payment. When a patient is scheduled for a surgical or invasive procedure, my job is to provide that patient with the best perioperative experience possible including anesthesia care and pain management. With regard to Medicare, I have previously discussed the components of value-based purchasing. Whether we agree with them or not, these metrics covering clinical processes, patient experience, and outcomes are here to stay. As physicians specializing in pain medicine, we need to take on leadership roles in our hospitals and focus on proving the value of our services. This will mean collecting and presenting data related to better patient outcomes and cost savings.

Interested in being featured in “The Refill”? Email CJ Arlotta at [email protected]