Clinical and Economic Impact of Intra- and Postoperative Use of Opioids and Analgesic Devices

Having just spent the early years of the 21st century focusing on what Congress declared as the Decade of Pain Control and Research, the health care community has made substantial progress in pain management. Working in collaboration with its partners in the Pain Care Coalition, the American Pain Society has been advocating for the passage of the National Pain Care Policy Act, which calls for numerous provisions, some of which include the establishment of 6 regional pain centers, the creation of a national pain and palliative care research and quality program, and a mandate requiring that American military personnel, veterans, and Medicare enrollees receive appropriate pain care services. California has made medical license renewal contingent upon completion of a pain management continuing education program. In another monumental step forward, The Joint Commission issued new standards mandating that pain be considered a ‘‘vital sign,’’ in effect making it compulsory for health care professionals practicing within accredited health care facilities to enquire about, measure, and treat pain as they would temperature, blood pressure, pulse, and respiratory rate. Within the institutions at Saint Barnabas Health Care System (SBHCS), clinical and staff pharmacists play an integral role in the assessment and management of pain. At these facilities, clinical pharmacists participate in multidisciplinary pain committees and incorporate pain management into daily medical rounds, making certain that patients are receiving adequate pain relief and side effect management. At one of the acute care facilities, the pharmacy department has created a schedule of rotating pharmacists who make daily visits to inpatients identified as having low Hospital Consumer Assessment of Health Plans Survey (HCAHP) scores. One of the major reasons why hospitals receive poor HCAHP scores is related to patients not being given adequate drug information. As such, pharmacists at SBHCS assess patients for appropriate analgesic therapy and focus on counseling them regarding expected outcomes/expectations and potential side effects of opioid therapy, as well as the importance of reporting alarming signs and symptoms. SBHCS pharmacists also emphasize to patients that they need to voice any inadequate pain relief, as we are well beyond the days where patients were expected to suffer from pain stoically. At SBHCS’s other practice site, a behavioral health facility, pharmacists regularly perform pain assessments on inpatients and outpatients, meet with patients to discuss successes and failures of previous and current treatments, work closely with physicians to develop individualized pain management plans, and perform close patient follow-up. As SBHCS marks its successes by welcoming the opportunity to effectively manage pain with multiple modalities and accepting the challenges of balancing the benefits and risks of analgesia, its progress is somewhat overshadowed by the acknowledgment that gaps in assessment and treatment still exist. As one editorial somberly reflects, despite sophisticated research institutions, questions remain about the nature and effects of pain, and as such, the need to re-examine meanings and values inherent to the experience and expression of pain. Technology provides invaluable tools for diagnoses and treatments, but technology alone does not provide the diagnosis, heal the patient, or sustain the profession and practice of pain medicine. This point is well-illustrated by evidence indicating that despite medical, technologic, and pharmaceutical advancement in the past decade, inadequate management of postsurgical pain (also called postoperative pain) remains common. With more than 70 million surgeries performed annually in the United States, postsurgical pain is a ubiquitous condition among the population. Although it is a predictable component of the recovery process, such pain is often poorly managed,