The opioid epidemic has forced frontline providers, clinical researchers and even patients to think about better ways to manage post-op pain. It’s no easy task. Ask 10 different patients who underwent the same procedure about their level of discomfort, and you might get 10 different answers. That’s why new approaches to keeping patients comfortable after surgery must be based on knowing how much they’re hurting.
1. Quantifiable scores
Innovations in pain monitors offering the promise of a reliable, objective system for measuring and monitoring pain could soon be a reality. Anis Dizdarevic, MD, the director of regional anesthesia and acute pain medicine at Montefiore Medical Center in the Bronx, N.Y., says pain monitors employ the analgesia nociception index (ANI) and nociception level (NoL) index. These measurements are based on capturing changes in different parameters such as heart rate, respiratory rate, sympathetic tone and parasympathetic tone, and providing a number or “index” that represents the patient’s level of nociception — the sensory nervous system’s response to harmful or potentially harmful stimuli.
Essentially, pain monitors take into account the physiological factors that are affecting patients under anesthesia, put them into an algorithm and provide an accurate reading of the level of pain they’re likely to be in — and the corresponding level of analgesia they’re likely to need. Compare that to the current level of pain “monitoring,” which involves providers looking for variations in a single parameter.
“They may see an elevated blood pressure, while all other readings are stable, and treat that blood pressure thinking the patient is in pain,” says Jacob Hutchins, MD, MHA, executive medical director of M Health Fairview ASC in Minneapolis. “But if the patient’s baseline blood pressure was [the only parameter that was] elevated, it’s unlikely they’re in discomfort.”
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