Multimodal Approach a Good Choice, Particularly for Older Patients
Numerous research studies point to effective pain management as a key factor in a patient’s overall satisfaction with hospitals and outpatient surgical centers. Not surprisingly, effective pain management also has a positive impact on a medical facility’s bottom line. Yet researchers have noted that, in three out of four surgeries, patients are not receiving multimodal pain management techniques, which combine pain medication with other therapeutic measures, to lessen unwanted post-operative side effects and improve recovery. While multimodal pain management can be beneficial in almost any circumstance and with most surgical patients, it is the preferred choice for managing post-operative pain in elderly patients because these techniques are known to have fewer complications.
One of the main reasons healthcare providers do not use multimodal pain management techniques is a lack of education about the benefits to both the patient and the hospital, and a misconception that it is more labor intensive. Surgeons, anesthesiologists and nurses all play an important role in delivering effective pain management. As a multi-specialty, hospital-based practice management company, Sheridan Healthcare has the benefit of conducting informal studies at its hospitals throughout the country to determine best practices for evolving better patient care. One of its findings has shown that multimodal pain management, particularly in the case of elderly patients, results in patients experiencing decreased pain and confusion and almost no nausea or vomiting. Typically, they are discharged sooner and generally with minimal narcotics, resulting in an easier and quicker recuperation period than those who are prescribed narcotics to control pain.
To relieve suffering, shorten hospital stays, reduce costs and increase patient satisfaction, consider multimodal pain management as an effective alternative to traditional analgesic therapy.
View the patient as a whole. Medical professionals who take a multimodal approach to pain management are embracing a philosophy that takes into consideration the whole patient. Prior to admission, evaluate the patient and the procedure being done, and consider the full spectrum of appropriate measures.
Take an individualized approach. Depending on the type of procedure and the patient’s history – for example a patient may have a history of experiencing post-operative nausea – pain management can begin at home the night before being admitted. Consider the needs of the individual patient, including one’s level of fear or anxiety, personal preference, age, response to agents given, and medical, psychological and physical condition.
Practice preemptive medicine. Part of the philosophy of multimodal pain management is being preventive or preemptive, rather than reactive. The goal is to prevent any post-surgical problems or unfavorable outcomes often associated with recovery. For example, most people will state that they fear experiencing postoperative nausea and vomiting even more than the pain they might have post-surgery. Use medications up front to prevent this unwanted side effect.
Minimize narcotics. Since narcotics cause many of the unpleasant side effects often associated with the recovery phase of any surgery, minimize the use of narcotics for a more pleasant post-surgical experience. Instead, a more effective pain management approach is to use several different agents in much smaller doses and lessen the side effects while still providing adequate pain relief. Pain has a variety of causes, and a combination of medications in decreased dosages will act on different sites of the pain pathway to relieve pain while avoiding the unwanted effects associated with the higher doses that would be required if only a single agent was used.
Failure to treat surgical pain adequately can result in lifelong chronic pain. With 32 years of experience treating patients, I believe in the multimodal approach to pain management and have witnessed its positive effects on both patients and medical facilities.
