In a series of articles for Whirl magazine, Sven Hosford explored the opiate crisis as seen through the eyes of of three mothers. Each was introduced to opiates. All this leads to a fuller, more productive and more joyful life. “The Opioid-Free Pain Relief Kit is a workbook for people with chronic pain and in my mind it is an . Dr. Samuels has practiced opioid-free anesthesia for more than two years. " Once they see the results [of opioid reduction], the strategy sells.
Living Free Strategies Opioid for
As necessity breeds invention, clinicians and healthcare organizations are working to develop multimodal approaches to pain management with limited reliance on opioids and opioid-free methods of anesthesia to effectively manage pain and reduce the likelihood of patients developing opioid addiction. A growing body of evidence suggests reducing reliance on opioids in the healthcare setting can ultimately improve care outcomes while simultaneously reducing patient exposure to opioids, which ultimately reduces the likelihood of addiction.
A June study published in JAMA Surgery found prolonged opioid use to be a common post-surgical complication among patients who underwent major and minor surgery and were not previously exposed to opioids. Researchers determined the rate of persistent opioid use — defined as filling an opioid prescription between 90 and days after surgery — was 6.
Samuels has practiced opioid-free anesthesia for more than two years. Samuels and his colleagues published a study in the Journal of Clinical Anesthesia in March demonstrating opioidfree anesthesia can help reduce post-operative opioid use.
The study involved hundreds of surgical patients treated with either opioid-based anesthesia, opioid-sparing anesthesia or opioid-free anesthesia. Samuels and team found the opioid anesthesia group required double the amount of post-operative opioids as the patients who did not receive opioids during anesthesia. Samuels and his colleagues said these results were partly attributable to the removal of the potent synthetic opioid fentanyl from the analgesic regimen.
Exposure to fentanyl can result in opioid induced hyperalgesia, which means patients develop increased pain sensitivity due to exposure to the drug. Because patients who aren't treated with fentanyl have fewer and less severe post-surgical symptoms, they typically utilize fewer healthcare services and are associated with decreased spending.
For instance, researchers associated preoperative opioid use among elective surgical patients with an increased likelihood of being discharged to a rehabilitation facility or readmitted into the hospital within 30 days, thereby driving healthcare spending and utilization, according to study published April in the Annals of Surgery. Besides improving pain management, limiting opioid-related side effects carries added fiscal benefits amid a healthcare reimbursement landscape that is increasingly shifting to value-based payment models.
Eliminating or reducing opioid-related adverse events in hospital settings has the potential to generate significant cost savings, studies show. Adverse events related to opioid use that occur in the hospital setting include respiratory depression, nausea, vomiting, urinary retention and constipation. Researchers identified significant increases in inpatient, outpatient and emergency department costs among nonelderly patients with opioid-induced constipation and non-cancer pain.
Among elderly patients with non-cancer pain, opioid-induced constipation was associated with higher inpatient and ED costs. In , the Advisory Board published an analysis estimating the fiscal impact of implementing multimodal pain management approaches and reducing high-dose opioid use.
Pease says multimodal pain management programs, which involve two or more non-opioid analgesics, offer significant opportunities for cost avoidance and cost savings. Less time in the recovery area leads to cost savings. Also, less incidence of nausea leads to savings in medication costs. When outlining the building blocks of opioid-free anesthesia and multimodal pain management programs, Enrico Camporesi, MD, professor emeritus at the University of South Florida in Tampa and director of research for TeamHealth Anesthesia Research Institute, described patient education as crucial to success.
However, before patient education can take place, providers must receive education on the substantial benefits of multimodal and opioid-free pain management techniques. Organizations should empower their care teams to gain knowledge on the subject and educate patients on opioid risks and alternative pain management techniques. Providers have to convince patients that nothing is being taken away from them, and patients have to buy into the process.
To educate its providers, TeamHealth offers Continuing Medical Education credits through an online platform. TeamHealth clinicians are required to complete about 10 online opioidreduction training modules as part of the organization's risk management training requirements. Moving anesthesiologists and nurse anesthetists away from opioids represents a major cultural change. Such a shift requires concerted education efforts targeting the entire perioperative staff, according to Dr. Acceptance happens when people give up the struggle to completely control their pain and are willing to live a satisfying life by engaging in valued activities, like exercise.
We found that adults reporting greater acceptance of their chronic pain from arthritis also participated in higher levels of moderate to vigorous intensity exercise compared to those with lower acceptance. In fact, individuals with higher acceptance exercised for over minutes in a week — well above the health-promoting duration of minutes each week. Recently, we also examined resiliency and how it related to whether people with chronic pain exercised or not.
In preliminary work with one of our graduate students, Miranda Cary, we found that people who are more resilient exercised more at moderate to vigorous intensities. They also had fewer symptoms of depression and less anxiety about their pain. Another psychological factor important for exercise participation is the confidence to cope with pain and related barriers, like fatigue and stiffness. We have found that the more confidence individuals have that they can use strategies to cope , the higher their exercise levels.
More confident individuals also persist longer and harder in using coping strategies when faced with challenging barriers compared to less confident individuals. How can these psychological factors pain acceptance, resiliency, confidence to cope be improved among individuals living with chronic pain? Practising mindfulness, or being present in the moment, may also be helpful.
Many mindfulness apps are available for use on smart phones and tablets. Building confidence to cope with pain and related barriers takes planning and practice. Susan Tupper at the Saskatchewan Health Authority. Other strategies can be identified via brainstorming with others who have chronic pain, as well as health-care and exercise providers, and using online search engines. Once people try using strategies, and figure out which ones work, this builds their confidence and exercise levels.
Ultimately, exercise helps individuals better manage their chronic pain. The poetics of retreat: Meditation and space at the shrine in Mahan — York, York. Films in translation — voices for all: The romance of Italy — Egham, Surrey. Available editions United Kingdom. Exercise reduces pain intensity Pain is considered to be chronic when lasting beyond an expected time for tissue healing , usually three to six months or longer, and it is not due to cancer.
President Donald Trump calls for drug traffickers to face the death penalty as part of his plan to combat opioid drug addiction on March 19, , in Manchester, N. Acceptance of pain is key Early in our own research, we expected pain intensity to be the main barrier to participation in exercise.
Resiliency and confidence Recently, we also examined resiliency and how it related to whether people with chronic pain exercised or not. Exercising with chronic pain is effective but not easy; it requires nurturing psychological capacities such as acceptance, resilience and confidence.
Shutterstock In preliminary work with one of our graduate students, Miranda Cary, we found that people who are more resilient exercised more at moderate to vigorous intensities.
Mindfulness as a strategy How can these psychological factors pain acceptance, resiliency, confidence to cope be improved among individuals living with chronic pain?
Found this article useful? You might also like At present, surgeons vary widely in their approach to opioid prescription and some patients use opioids for prolonged periods post-surgery. The use of more than four medications by one patient is frequent. A woman holds a photo of her best friend, who died of a drug overdose in January , before a march to draw attention to the opioid overdose epidemic, in the Downtown Eastside of Vancouver, B.
President Donald Trump displays a presidential memorandum he signed, declaring the opioid crisis a public health emergency in the East Room of the White House, Oct. Most popular on The Conversation Tiny houses look marvellous but have a dark side: Expert Database Find experts with knowledge in: Community Community standards Republishing guidelines Friends of The Conversation Research and Expert Database Analytics Events Our feeds Donate Company Who we are Our charter Our team Our blog Partners and funders Resource for media Contact us Stay informed and subscribe to our free daily newsletter and get the latest analysis and commentary directly in your inbox.
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Module 2: Treating Chronic Pain without Opioids
Like Scheib, an estimated million Americans live with long-term pain. released a “National Pain Strategy” in that emphasized many. Life Chiropractic College West and Director, The Octagon, Life University .. care offers a drug-free, non-invasive and cost-effective alternative to opioid drugs. While opiates are undoubtedly effective at relieving pain, these drugs can also are alternatives available that will not disrupt your balanced, substance-free life. put their focuses elsewhere, and develop strategies to adapt and conquer any .