Mitigating through a Nationwide Pain Crisis

1. Having extensive experience in the domain, how would you describe the development of pain management in the hospital industry to this day?

The challenge is pain medicine is practiced differently depending on where you go. Some places have a dedicated pain service that provides consultation to admitting teams to manage acute and chronic pain conditions.  Many hospitals do not have a dedicated pain service and the admitting service manages pain themselves.  There is a great deal of variability in the quality of care in pain medicine.

“We must decrease opioids in the community, which fuels opioid misuse, abuse, and overdose in this country across all ages, by implementing pain protocols that guide healthcare practitioners who have at best received fragmented pain education.”

Ideally, every hospital should have a team that is dedicated to ensuring appropriate pain assessment and treatment on an organizational level by developing protocols, policies, and procedures. Having a hospital-wide pain committee can facilitate this aim.

2. What are some of the new trends that hospitals are leveraging to treat patients with chronic pain?

Given the level of heterogeneity when it comes to managing pain across this country, it is unclear what new trends hospitals are choosing to adopt on a wide scale. However new trends in chronic pain include advances in regenerative medicine, radiofrequency ablation, and neuromodulation.  Regenerative medicine uses biological materials to promote tissue healing- platelet-rich plasma and mesenchymal stem cells are used in adult populations to decrease inflammation in musculoskeletal conditions. Radiofrequency lesioning where sensory nerves responsible for transmitting the nociceptive signaling are burned is not new however more facilities are performing this procedure in adolescents.  We still have a way to go as far as determining the long-term outcomes of such techniques.  In chronic pain, the nerves that provide nociceptive signaling are often over-firing resulting in stabbing, burning pain.  Neuromodulation uses electrical signals to promote normal neuronal signaling and disrupt the over-firing of these nerves.  Spinal cord stimulation is an invasive procedure and designed to be a permanent implant but new advances such as temporary peripheral nerve stimulation- are not as invasive procedurally and can be removed after a few months with long-lasting benefits.

3. In extension to the above question what would you say are some of the challenges that caregivers and hospitals go through while delivering treatment to patients?

The challenges healthcare professionals have in treating pain largely lie in the bureaucracy. Much of pain management in this country is dictated by dogma- “this is what my attending did and so this is what we will do”- it is not tailored to the patient or the current clinical scenario.  Far too often when a patient is admitted after a procedure, even if the patient did not require an opioid for days, the patient is still sent home with an opioid.  This practice must stop.  We have to decrease opioids in the community as this fuels opioid misuse, abuse, and overdose in this country across the age spectrum.  We need pain protocols that guide healthcare professionals who at best received fragmented pain education if any at all.  All hospitals should have a centralized hospital pain committee to coordinate these efforts.

4. Can you give us a brief background about your roles in the organizations you've worked for? How does the experience augment your role and responsibility at your current organization?

Clinically, I serve as director of chronic pain at Children’s National, and academically, I serve as the associate program director for the George Washington pain fellowship.  I have a passion for educating other faculty, trainees, and the public on pain medicine. Through serving patients, I regularly hear the concerns families have surrounding their pain treatment and pain experience. Too often patients share how a physician told them that their “pain is not real” and “it’s all in their head”.  Comments like this reveal the lack of pain education we have in this country and how damaging it is to our most vulnerable patients- children with chronic pain.  This lack of education also fuels the grave gender and racial disparities in pain care in this country.  Because when we don’t have education, we rely on biases that exacerbate these inequities.

5. As an ending note, what is your advice for other senior leaders and CXOs working in the healthcare industry?

The United States is in a pain crisis.  We need a unified organized effort to mitigate this crisis.  All hospitals in this country should have a pain service and a centralized pain committee to track and examine current pain practices organizationally and their effectiveness in decreasing pain and promoting function.  Studies have found having pain protocols with regular benchmarking that includes feedback and staff education is necessary for improving pain management organizationally.

Such processes improve patient and staff satisfaction and improve function and outcomes.  These processes save the hospital money while improving patient care- it’s a win-win.