As anesthesiologists, one of our biggest concerns is and always will be relieving pain. This will never change, but the strategies we employ to manage our patients’ pain continues to evolve.
As the pain literature grows, we continue to learn more about the importance of minimizing physiologic stressors during surgical procedures using non-opioid, multi-modal pharmacologic and non-pharmacologic approaches. The days of escalating opioids to control pain are over, and here to stay are specialized protocols and techniques that more precisely target pain receptors and are individualized to each patient.
In this pain management themed issue, authors have submitted well-researched and evidence-based articles, broadly covering topics ranging from implementation of ERAS protocols and their importance, to where we stand in the current opioid epidemic. You will also find a relevant article on the perioperative management of spinal cord stimulators and intrathecal drug pumps, as these patients return to the operating room with other surgical issues.
One of the most interesting and thought provoking articles is a science based review of how one’s sex, gender, immune system, and individual gene expression can alter pain experiences, even when given identical pain stimuli. Pain management is such a diverse and expansive topic and it is our hope to provide a broad and helpful overview. The management of pain is one of the key areas where physician anesthesiologists’ specialized education, training and research can differentiate ourselves from other health care professionals.
The negative long term impact of opioids for patients are well known to all of us and several efforts have been made to curb their use. One author reviews the impact of the 2016 public health emergency declared by the CDC which issued new prescribing guidelines to physicians in an effort to reduce the number of opioid prescriptions written.
Virginia has taken several steps in line with the CDC guidelines including the implementation of the Prescription Monitoring Program (PMP), which requires prescribers to review and report dispensed controlled substances. Many institutions have incorporated it into their electronic medical records, which has dramatically contributed to the program’s widespread use. Also, a physician cannot renew their Virginia medical license without first completing two continuing medical education credits on safe opioid prescribing.
In accordance with opioid mitigating efforts, more medical centers are now hiring experts in ultrasound-based regional anesthesia techniques and creating Acute Pain Service teams that specialize in post-operative pain management. Patients not only benefit from better pain control, but they are less likely to suffer long term negative sequelae from escalating opioid usage. It has taken the medical community an opioid epidemic and several decades of learning to realize the benefits of specialized perioperative pain services and customization of pain management for our patients.
As anesthesiologists, we are tasked with keeping our patients safe and comfortable. This is the promise we make to our patients everyday. They come to us in their most vulnerable state, putting complete faith and trust in the decisions we make, many of which can have long term consequences.
Striking a balance between administering too much or too little is a constant struggle and the reason why we continue to strive for evidence based research to guide our management. We thank the authors who have contributed to this meaningful discussion and hope this very important newsletter themed on pain management brings awareness to your practice.
Your VSA board represents you and all Virginia anesthesiologists, and we want to make sure that your voice is always heard. Your President and President-Elect, encourage you to become more involved in your society.
Please contact us if we can better serve you or if there are any issues/topics you would like addressed in future newsletters. Thank you once again to all the authors around the state of Virginia who have put their heart and soul into producing another great quarterly publication of the VSA UPDATE newsletter.