Help Patients Manage Pain Wisely Come to ASCA 2019 to learn how BY STANFORD R. PLAVIN, MD

As a practicing anesthe- siologist with 20-plus years of clinical experi- ence in both the hospital and ASC practice environ-

ments, I have witnessed patient expec- tations changing dramatically. I have experienced the challenges associated with providing a relatively “pain free” patient care experience. The physician community is focused on patient satis- faction and high-quality outcomes, and rightly so, but at what cost is that deliv- erable being embraced?

Simply saying that an opioid crisis or epidemic is related to our expecta- tions for a pain-free encounter or expe- rience would be misguided to say the least, however, unrealistic expectations of pain-free surgery do likely contrib- ute to the opioid epidemic in the US today. When a surgeon tells a patient that their surgery will be pain-free, the patient comes to the operating room expecting just that. Many require pain medication to fulfill those expectations set by their surgeons. There is plenty of responsibility to go around, not the least of which is the patient’s own level of accountability with respect to their care. As I write this column, I realize that what I am saying could be con- strued in a way that sounds a bit cal- lous, but that is not my intent. My point is that the physician community, and especially those in the periopera- tive setting, need to realize that we are complicit in enabling this behavior of opioid misuse and abuse to continue. What can be done to change the nar-

rative? I believe the dynamic is, in fact, changing already. Over the course of the last few years, we have acknowl- edged a public health challenge associ- ated with opioid abuse and subsequent opioid use disorders and deaths. We also have agreed that setting expectations


Providing alternatives to opioids is just part of the solution; engaging, educating and empowering patients to be accountable will be paramount in their experience and ultimately the success of their care.”

—Stanford R. Plavin, MD, ASCA Board member

and having real conversations with our patients must be a priority when provid- ing care in every practice setting. The ASC community has been

actively engaged in working to find solutions and options for its stakehold- ers and the patients we treat. ASCA is committed to providing education for its members as well as engaging the policymakers locally and nationally to create meaningful solutions. At the ASCA 2019 Conference & Expo, May 15–19, in Nashville, Tennes- see, we have an educational track high- lighting the specific challenges, oppor- tunities and responsibilities that we, in the ASC community, must embrace for our patients. As part of this initiative, I was asked to prepare a clinically based lecture articulating alternative treatment modalities de-emphasizing the use of opioid analgesics and their use in the perioperative setting and beyond.

Basics of ‘Opioid-Free’ True, not every patient is a candi- date for an opioid-free anesthetic, nor


should they be, but the focus should be on alternative pathways to cre- ate a responsible patient care expe- rience without the use of opioids. As Enhanced Recovery after Sur- gery (ERAS) techniques continue to be finely tuned and value-based solu- tions and alternative payment mod- els (APM) proliferate, clinicians have a tremendous responsibility. We need to create a patient care experience whereby we engage them in a manner that provides education and sets expec- tations for their care. We should iden- tify and develop care plans that show the inherent value of reducing opioid use not only before, but also during and after the episode of care. I am sure many patients are not

familiar with prescription drug moni- toring plans (PDMP). It is important to let them know that limited prescriptions will be given with respect to their post- surgical pain expectations. Setting these parameters is an important step in help- ing our patients understand the process and goals associated with their care.

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