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Archive March 2019 XX, No. 3

Pain Is Personal

Patients do well if you do away with a one-size-fits-all approach to managing their post-op discomfort.

Daniel Cook

Daniel Cook, Editor-in-Chief


Jack Newman, Duke Anesthesiology
ONE AND ONLY Anesthesiologist Padma Gulur, MD (right), and her colleagues at the Duke Perioperative Pain Care Clinic consult with patients leading up to surgery and support their recovery for 90 days post-op.

Most patients who are hooked on opioids know exactly when they started down the slippery slope of addiction, and many think back to heading home from surgery with a pocket full of pills to overpower post-op pain.

The Duke University Health System in Durham, N.C., may have been unwittingly contributing to the nation's prescription drug abuse epidemic by sending patients home with excess amounts of opioids — they typically used only 30% of the pills they received and most did not dispose of the leftovers.

"Patients received stock prescriptions for pain medications at discharge because there was no infrastructure in place to assess their condition and adjust their care plan," says Padma Gulur, MD, executive vice chair of operations and performance at Duke Anesthesiology. "We saw a real opportunity to examine the surgical episode of care and explore ways we could do better."

Two years ago this month, she helped launch a perioperative pain care clinic with the goal of personalizing post-op pain management, minimizing the use of opioids, reducing the amount of time patients spend in recovery and increasing their overall satisfaction. Her large health system had the means and need — it treats 60,000 surgical patients each year — to launch a dedicated post-op pain clinic, but you can implement a similar program on a smaller scale. The key is to focus on the unique pain management needs of your patients weeks before procedures instead of relying on a cooker-cutter approach on the day of surgery that's often ineffective and unsafe.

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