Archive February 2014 XV, No. 2

Anesthesia Alert: Give Your Pain Service a Shot of Efficiency

10 tips for treating chronic pain more quickly, safely and profitably.

Jackie Rowles, CRNA, MBA, FAAPM


pain treatment therapies TARGETED RELIEF Ms. Rowles provides such pain treatment therapies as spinal injections with fluoroscopy, joint injections and peripheral nerve blocks.

Pain is very difficult to diagnose and treat because multiple pain generators cause the same symptoms. Work with your patients to overcome this challenge and do all you can to eliminate pain from their lives through multimodal therapy that combines medications, physical therapy, injections and psychological interventions. Read on for 10 keys to an efficient pain service.

Require new patients to bring in all medicines. Most chronic pain patients are on multiple medications, and they rarely remember what medicines they're taking, the dose or the frequency. This information is critical to delivering safe, appropriate care, so we instruct new patients to bring all of their medicines, including vitamins, herbs and supplements, to their first appointment. This is the only truly effective way to document exactly what medicines patients are taking.

Reconcile medication lists at every visit. A patient's medicines can change in between visits, so reconcile their medication list at every appointment. Print out the list of medications you entered into the patient's file during their previous visit, and require patients to review this list to let you know if there have been any changes. Medications interact with each other in many different ways. Be sure to take any changes into account when determining a treatment plan.

Use a consistent pain scale rating system. Because there's no universally accepted and adapted pain rating scale, scales differ from facility to facility. We can't control what happens in other facilities, but we can control what happens here, so we make sure to use the same pain rating scale every time for every patient visit.

Whenever patients come in, hand them a hard copy of your rating scale, review it and remind them how you use the scale to assess their pain. We've had patients come in and say their pain is a 10, but a 10 on our scale means emergency care is required, so they'll then adjust their rating to our system. Have patients use this scale to rate their pain, function limit due to pain, anxiety and depression. By having patients use the same rating scale each visit, we're able to identify whether patients are actually seeing improvement in these different areas and adjust our care accordingly.

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