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Recovering quickly and safely



pain management team at Indian River Medical Center in Vero Beach

The pain management team at Indian River Medical Center in Vero Beach includes, from left: Dr. Geoffrey Wolf; Sarah Mondano, BSN; Dr. Kathy Grichnik; Louis Solomon, RN; Karen Scrivert, PharmD; Dr. George Nichols; and Brian Wiley, D.O.

Hospitals focus on pain management, fewer drugs, for patient healing after illness, trauma and surgery

BY GREG GARDNER

Treasure Coast medical professionals are using advanced pain management techniques to provide better outcomes, much shorter hospital stays and reduced risks of opioid addiction.

From Vero Beach to Stuart, pain management teams are assessing what is the best treatment for each individual patient with the goal of prescribing as little opioid medicine as possible. This often begins before surgeries and is closely monitored through the post-operation period.

Opioids are effective for relieving pain and are safe if taken for short periods of time and prescribed by doctors. However, regular use may lead to dependence, misuse, overdosing and even death. They also have side effects that include nausea, vomiting, irritability, anxiety and loss of breath.

Multimodal analgesia with several different approaches gives the patients two or three medications in smaller doses for healthier results without side effects. If the patients are comfortable enough to be up and around after surgery, healing happens faster when they breathe better with good circulation.

“Pain management is a targeted approach crucial to treating patients with acute illnesses, trauma and recent surgeries,” explains Dr. Katherine Grichnik, senior vice president and chief medical officer at Indian River Medical Center in Vero Beach. “We have to think differently about trauma to muscles, bones and nerves as well as severe pain caused by cancer. IRMC has a robust pain team of eight to 10 people led by our pharmacy, anesthesia and nursing departments using the support of electronic medical technology. We are reducing complications and time in the hospital for patients. It is important to flag inappropriate or duplicative uses of medications to prevent problems during and after hospitalization.”

POSTOPERATIVE CARE
The anesthesia, surgery and pharmacy departments also work closely to manage the enhanced recovery after surgery (ERAS) program, recognized nationally for almost 10 years. “There is no one recipe for an individual using guidelines,” Grichnik says. “We have doctors making the rounds every day at the ICU (intensive care unit). The program is designed to prepare patients, coordinating and managing their care precisely with the goal of faster recovery with fewer side effects from different procedures.

“We studied it and implemented this as best practice,” she continues. “One of the most important components is multimodal pain management that minimizes opioid use. Any new program we reevaluate very deliberately. Our pharmacy, nurses, doctors and IT staff do a lot of brainstorming to make sure new programs work at IRMC.”

When pain is managed properly, patients can go home after surgeries in a few days instead of staying up to a month. “Patients participate earlier in their own care,” Grichnik states. “If you are not sick to your stomach and are comfortable, you can get up, walk around and have physical therapy. Deep breathing helps prevent pneumonia and blood clots. Wounds don’t hurt as much and patients are going home in a few days when they might have been in the hospital for 30 days.”

The euphoria resulting from opioids may lead to dangerous consequences. “Most seriously, if you take too much opioid (medicine), you don’t want to breathe,” says Grichnik. “The body metabolizes drugs and people become tolerant to the medication. We don’t want patients to get to the point of taking an opioid for a euphoric feeling instead of to relieve pain. Targeted multimodal analgesia and ERAS programs are a win, win, win for everyone. We champion this work because it is so important to the patients.”

After a hip replacement operation at IRMC in July, Marion White was home a day later and walking around. “It was amazing,” declares White, a 70-year-old math teacher and tutor. “I walked the day of the surgery, but I have taken nothing stronger than Tylenol. I got a prescription filled for pain pills but never used it.”

Martin Health System in Stuart has a pain management team of three doctors, two Harvard University Medical School graduates and the other a graduate of Johns Hopkins University Medical School. All doctors dispensing pain medication must be licensed by the Drug Enforcement Administration, which regulates how much they can prescribe and for how long.

“All of our pain management physicians are highly trained, and we try to find the root cause of the pain rather than throwing out opioid medicines,” says Dr. Amit Asopa, who came to Stuart from Harvard. “Initially, the role was for acute pain, but there is no evidence patients do well with chronic opioid use. Patients have to be monitored for good analgesia, signs of abuse and aberrant behavior. There has to be improvement in function and if not, we haven’t gained anything. Each and every patient has to be evaluated.”

RESTORE TO HEALTH
Exercise, physical therapy and rehabilitation are key elements of the healing process, according to Asopa. Martin Health uses a multi-faceted questionnaire to explore the patient’s psycho-social, anxiety, depression and physical history. The team can then determine whether there is a low or high risk when prescribing opioids.

Back pain and headaches are the two most common ailments for which patients seek help to endure pain. “We believe through multimodal pain management, we can control the way their pain is managed,” Asopa continues. “We can use anti-inflammatory, adjunct medicines and non-opioids to make sure the pain is managed appropriately to limit long-term impact. People get dependent and we are trying to avoid that, but not everyone is abusing medicines. It is for the overall good to try and limit opioids.”

Martin Health hospitals also use ERAS protocols, offering patients greater peace of mind. These protocols were designed to safely reduce hospital stays and pain medication while increasing patients’ satisfaction with their recoveries. It begins with an individual assessment when a patient is referred for surgery. Members of the care team look for ways to reduce stress on the body during surgery, helping bring about a faster recovery.

Depending on the individual, stress can be reduced through fluid and nutrition before and after surgery, the use of minimally invasive techniques and short-acting anesthetic agents, removing catheters and moving the patient sooner after surgery. The result is shorter lengths of stay and a quicker recovery period.

Martin Health System’s pain management team consists of Asopa, Dr. Alexander DeBonet, Dr. Zackary Boomsaad and their support staff.