Due to the dangers of opioid use, Shriners Hospitals is implementing new protocols and introducing alternatives to reduce the use of this class of medications. Here are some of the efforts we’re making to ensure safe and effective pain management for our patients.
At Shriners Hospitals for Children — Spokane, as well as other hospitals systemwide, all inpatients scheduled for surgery are seen by a staff pediatric anesthesiologist prior to the day of surgery to discuss expectations and plans for pain management. Standard non-narcotic analgesics, such as Tylenol or non-steroidal anti-inflammatory drugs, are provided for patients before surgery.
During surgery, additional non-narcotic interventions occur. These can include specific drugs or regional anesthesia, which uses local anesthetics (numbing medicine) to provide pain relief to a specific area of the body. It can be administered through an epidural or as a peripheral nerve block, which can last for three days. Pediatric anesthesiologist at the Spokane Shriners Hospital, Lloyd Halpern, M.D., has detailed the use of regional anesthesia to decrease opioid use and reduce pain during a specific knee procedure in a manuscript submitted to the Journal of Pediatric Anesthesia.
After surgery, non-drug treatments like ice, massage, exercise, physical therapy and relaxation training can be especially useful in treating pain.
A patient-focused mission
At the Spokane Shriners Hospital, our pediatric anesthesiologists treat children with expertise and compassion to help them feel comfortable and recover as quickly as possible. To further this mission, we have created detailed protocols for pain management. This reduces variability, improves patient safety and supports evidence-based care. In addition, we are leading a multisite survey of pain management and opioid use after hospital discharge.
“When opioids are required, patients and families are given the necessary information on the usage, safe storage and disposal of opioids,” said Dr. Halpern.
Shriners Hospitals for Children — Springfield is using cryoablation, a technique involving temporarily freezing nerves to ease pain after Nuss bar surgery to correct pectus excavatum, a chest wall deformity in which the breastbone sinks into the chest.
“Recovery from Nuss bar surgery is lengthy and often very painful for patients due to a sudden, dramatic change in their chest,” explained pediatric surgeon David Tashjian, M.D. “Cryoablation minimizes the need for pain-relieving narcotics after surgery.”
Brothers Hayden, 19, and Hudson, 16, both had Nuss bar surgery at Shriners Hospitals for Children — Springfield, two years apart. Even though they had the same procedure, they had very different experiences. Hayden spent a week in the hospital recovering, while Hudson went home the next day. The difference was cryoablation.
Limiting the use of narcotics was important to the boys’ mother, Amy. “We lost a relative to opioid addiction a few years ago, so this was really personal to us,” she said. “We were over the moon to hear that Shriners Hospitals offered a way to reduce the use.”
After his surgery, Hayden felt nauseated and had no appetite due to the pain medications he needed. He spent the next few months mostly on the couch. Hudson, on the other hand, was walking around shortly after his surgery. “Within a few days, he was making his own breakfast,” April recalled. “Both Hayden and Hudson received amazing care at Shriners Hospitals. But the addition of cryoablation was life-changing.”
The future of pain management
One of the goals of a new field of medicine created by investigators with the Research Center at Shriners Hospitals for Children — St. Louis is to prevent post-surgery pain by triggering a patient’s own cells to prevent it.
This new field is called mechanogenetics, and its first target is to stop the damage caused by osteoarthritis, a painful joint condition. The work by researchers with the St. Louis Shriners Hospital and its partner, the Washington University School of Medicine, was published online Jan. 27 in the journal Science Advances.
“Drugs such as ibuprofen and naproxen that ease joint pain and lower systemic inflammation are the main treatments for osteoarthritis pain, but there are no therapies that actually prevent damage in the joints of patients with this debilitating form of arthritis,” said senior investigator Farshid Guilak, Ph.D., director of the St. Louis Shriners Hospital’s Research Center. “Through mechanogenetics, we can engineer cartilage cells to respond to the mechanical loading of the joint. Every time cells are under that stress, they produce a biologic drug to reduce inflammation and limit arthritis-related damage.”
Guilak and his team’s research revealed key pathways in cells that respond to stress, said Robert J. Nims, Ph.D., a postdoctoral researcher in Guilak’s laboratory and the study’s co-first author.
Lara Pferdehirt, the other co-first author, a biomedical engineer and graduate research assistant in Guilak’s lab, said it’s like flipping a switch to turn on a light. “In this case,” she said, “the switch is the mechanical loading of a joint, and the bulb is the anti-inflammatory drug.”
Although this technology is still years away from being available, it could make a huge difference one day to people everywhere, including our patients and former patients, many of whom may be at risk for osteoarthritis.