Note that I am an ACUTE (NOT chronic) pain specialist. I am an Anesthesiologist, and I work at a major trauma hospital (the 3rd busiest Level 1 Trauma Center in the U.S.) in Memphis where I relieve pain and suffering after surgery/trauma by utilizing techniques and medications that minimize the need for opioids and also often hasten recovery. I was in private practice for 12 years where I honed these skills. When I was recruited into academics at UTHSC/ROH, I started focusing on major traumatic injuries. We are now leaders in the country in applying continuous peripheral nerve blocks to traumatic injury.
The opioid crisis claims the lives of American citizens (very often starting after exposure during surgery or trauma) every 11 minutes. Having surgery and even receiving an opioid prescription when leaving the hospital is a Risk Factor for long term use and substance use disorder (addiction). Even 1 week exposure to opioids could begin some of us on a life-altering path of addiction.
Addiction hits all classes, races, and professions. Avoiding exposure is key in preventing addiction and in 're-triggering' those who have recovered. The 'minor' consequences of opioids (constipation, nausea, 'foggy-headedness', confusion) are not minor for individual patients, and they have significant, and often unrecognized, financial consequences. Further, patient call back studies confirm over and over that post-surgical pain is still not well controlled.
Most patients, physicians, hospital administrators, insurance carriers believe the only options are: PAIN or OPIOIDS. You should not believe that at all! The combination of MMA (multimodal analgesia - several non-opioid medications used together) and regional anesthesia (nerve blocks using local anesthetics -sort of like the dentist uses) that can be done nearly anywhere in the body can dramatically improve outcomes, patient satisfaction and reduce opioids. Now, utilizing ultrasound technology and tiny catheters with a bedside procedure, numbing medicine can be reliably delivered to hide pain for days or weeks! Even the horrible injuries (like rib fractures or limb amputations or both) that we see at ROH, we can reduce opioid use dramatically - sometimes by 90-100%!
There are many compelling reasons to implement these techniques and strategies in other hospitals, and it takes a system-wide approach to find success. Presently, not enough physicians are trained adequately to perform these techniques, and (although the literature is clear about the positive patient-centered & financial outcomes), there is always difficulty in shifting from the 'status quo', and there is inadequate incentive for hospitals and physicians to change practice. I believe when patients become aware that they have better pain control options, and they don't have to choose between pain or opioids (or both!), things will change. I have been in hospitals that 'stole' many, many cases from nearby towns JUST because we were using these strategies. I also believe that when hospital administrators realize that they are hemorrhaging money with their current over-reliance on opioids that change will occur. I believe that when insurance carriers and government organizations realize that 6-7% of 40-50 million surgical patients will become long-term opioid users after surgery with our common (out-dated) ways of controlling pain after surgery...and that they spend $15,000/year more caring for these patients, then change will occur.
I want people out there to know that they have much better options available and that they should seek out hospitals and physicians who practice in this way. The benefits to some patient populations is greatly magnified. Individual patients and family members can create the incentive that is needed to bring about change. Sometimes I don't think that I can keep up the fight to make this change a reality. It would be far less stress and strain for me to 'just do regular Anesthesia.' Whenever I get to this point, I will run into an appreciative patient or family member or surgeon, or I will see a previous patient on Facebook, and that always seems to remind me that I've gone way too far to give up now.
I am working with colleagues from Penn State and UAB on a $7 million NIH-funded grant proposal to study how acute pain after rib fractures turns into chronic pain. I have been speaking at academic meetings, universities and local hospitals on this topic over the past few years with a recent visit to Penn State and an upcoming workshop at Emory University. I am also speaking on a few podcasts for the Trauma Anesthesiology Society about some newer types of continuous peripheral nerve blocks used for rib fractures. I hope to initiate training courses through UTHSC and start a Fellowship program for graduating Anesthesiology Residents to study this sub-specialty of Anesthesiology.
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