The words pain management may be perceived very differently today than they were 30 years ago. In the 1990s, we realized pain was still being undertreated due to a lack of knowledge and recognizing that quality care means that pain is identified and measured. Early in my career, I recall giving IM injections of pain medications that caused pain to help with managing sickle cell and cancer pain. In the early 2000s, governmental agencies and governing bodies determined it was time to step in to help with doing a better job with treating pain implemented standards on pain assessment and gathering patient satisfaction on their pain management. Many people’s perception of this was the expectation thatmanaging painmeantno pain. While this was not the intention of many of the initiatives to recognize and manage pain, this was the path that many people followed, and the expectation for managing pain was to get a pain score as close to zero as possible. Unfortunately, the words pain management today can be scary and dark words for some people, especially in the midst of an opioid epidemic. Certain people are afraid to appropriately manage their pain if strong medications are necessary due to the fear of addiction, the shame, guilt, and judgment that comes with the stigma of being a pain patient, being labeled as a drug seeker, or even concerns for safety with having needed medications in the home. However, we are fortunate in the current healthcare field as there is a bigger push for providers to use a multimodal approach when managing pain, and there are many more non-pharmacological and pharmacological treatment options for managing pain.
Currently, there is a lot of work being done with healthcare organizations when working with patients with acute pain, especially related to surgery, trauma, or injuries, with opioid stewardship projects and utilizing a multimodal approach when treating pain. Some best practices to help with an opioid stewardship program would be: gathering baseline information regarding healthcare providers’ (physician and nurses) knowledge and clinical practice about opioid prescribing; education on pain management and opioid safety, which is important to determine areas for opportunity for opioid education, as well as to document the change in knowledge and practice after implementing the Opioid Prescribing and Safety Stewardship project. Many states have specific rules for opioid prescribing practices. It is important to identify all the state rules, guidelines, and accrediting organization standards to ensure compliance of your organization. This should be included in educational content developed for your stewardship program. Looking for opportunities to use regional anesthesia approaches with blocks, peripheral nerve catheters, and use of epidural analgesia can be a way to minimize opioid exposure and improve postoperative pain control for patients.