Study explores post-surgery pain management

Compassionate and effective pain management after surgery represents a foundation of humane medical care. 

But there has to be more to that care than just sending patients home with a prescription for an opioid, said Karsten Bartels, MD, PhD, the Lieberman Endowed Chair in the UNMC Department of Anesthesiology. 

And while opioids are still the mainstay of post-surgical pain therapy,  with up to 80 percent of patients being prescribed them at discharge, Dr. Bartels hopes to find other ways which minimize the use of opioids but still achieve excellent pain management for patients.

Through the "Efficiency and Quality in Post-Surgical Pain Therapy After Discharge — EQUIPPED" study, Dr. Bartels and others will look at individualized pain therapy and non-opioid pain management strategies.  

The five-year study is funded by a $2 million R01 grant from the Agency for Healthcare Research and Quality. 

According to the Centers for Disease Control and Prevention, since 1999 nearly 841,000 people have died from a drug overdose, and more than 70% of those deaths involved an opioid. 

"There is an urgent need to increase access to high-quality, safe and scalable interventions to reduce our reliance on opioids for effective post-surgical pain management at discharge," Dr. Bartels said. 

The EQUIPPED study will look at how to better use the electronic health record (EHR) system to help physicians make more informed decisions when it comes to prescribing pharmacologic and non-pharmacologic pain therapy for their patients upon discharge from the hospital. 

"Through innovative utilization of the EHR system, we hope to help physicians provide individualized pain therapy for their patients through modifications to the system that will automatically show the provider a window with information on what that patient received to manage their pain during their hospital stay," Dr. Bartels said. 

The provider can then better determine what that person will need when they go home to help them manage their pain, he said. 

The study also will explore non-opioid pain management strategies, such as using acetaminophen and non-steroidal anti-inflammatory drugs first and then educating the patient on how to best use these two medications to manage their pain. 

Dr. Bartels said that often combination opioids that include an opioid and acetaminophen are prescribed to patients, when all they might really need upon discharge from the hospital is to use acetaminophen intermittently with a non-steroidal anti-inflammatory drug for pain control.  

"We need to educate patients on how to effectively use these medications and then prescribe them in a way that actually allows them to do so," he said. 

The overarching goal of the study, Dr. Bartels said, is to get providers to take a more patient-centered approach and empower patients to take an active role in their pain management and recovery. His vision for the future extends beyond the immediate mechanical issue that brought the patient to surgery in the first place, taking a deeper look at the patient’s lifestyle, mental health, and overall wellbeing.  

"Not only is it important to address responsible management of opioid use in surgical patients, but also address overall mental health while the patient is with us," Dr. Bartels said. "We plan to leverage the resources provided by the EQUIPPED grant to transform clinical outcomes research. For example, by securing a share of the upcoming big-pharma opioid settlements to fund a future center for interdisciplinary clinical outcomes research at UNMC."  

He hopes the EQUIPPED study will lay the foundation to utilize surgical encounters to address issues such as substance use disorders and other aspects of mental health, thereby transforming public health in Nebraska and beyond.