There is no single solution to America’s opioid crisis. With more than 90 Americans dying each day from opioid overdoses, the nation needs comprehensive strategies from multiple stakeholder groups. Hospitals and physicians, of course, play a vital role.
Increasingly, healthcare providers are seeking alternative ways to help patients manage pain. Multi-modal pain management (MMPM) programs are one effective strategy for reducing the use of narcotics. In addition, they often offer patients a faster recovery with fewer side effects.
What is MMPM?
Multi-modal pain management aims to reduce or eliminate the use of opioids by combining two or more non-narcotic pain relief agents or techniques. A variety of medications can be used along with methods such as nerve blocks, spinal anesthesia or numbing agents that work together to target or prevent pain.
An MMPM approach can be even more effective than using opioids because it employs multiple mechanisms to attack pain at different receptors, while also eliminating many of the side effects (such as constipation, nausea, dizziness and drowsiness) and risks (such as respiratory depression) of opioids. As a result, patients experience better pain control and less nausea, constipation and drowsiness, which allows them to be more engaged in the recovery process. This often leads to shorter lengths of stay, greater patient satisfaction and fewer readmissions or ER visits following discharge.
It may also improve outcomes. A 2014 Advisory Board analysis found decreasing the use of opioids lowered complications by 36 percent.
Increasingly, anesthesiologists are relying on multi-modal techniques to manage pain during surgery. Opioid-free anesthesia (OFA) allows patients who have never taken narcotics to remain “opioid naïve” while reducing the need for an opioid prescription following discharge. Such programs can contribute to a faster recovery while also reducing the supply of opioids in the community.
Building an MMPM program
With the growing opioid crisis, more hospitals are looking to implement MMPM programs. But adopting MMPM protocols can be challenging given the widespread use of narcotics across various departments and specialties. To overcome common obstacles, consider these strategies:
• Build consensus by identifying clinical and administrative champions who can use their relationships to secure buy-in from other clinicians and nursing leaders. Getting everyone to share the same vision is the first, and often most critical step in building an MMPM program.
• Assess the current state of opioid use to identify benchmarks that can be used to gauge progress. Then align stakeholders around realistic goals for improvement.
• Reduce variation by creating standardized clinical pathways. For example, many facilities have implemented Enhanced Recovery After Surgery programs with standardized multi-modal pain medication order sets to reduce the use of opioids while also emphasizing early movement and greater education around pain management.
• Lean on experienced partners. Hospitals that partner with a physician group that has experience establishing MMPM programs benefit from access to expertise and established resources, such as skills labs to teach new blocks and regional anesthesia techniques.
Attainable results
Although MMPM and opioid-sparing programs are still gaining traction among some hospitals, others have already found success.
For example, All Saints Hospital in Racine, Wisconsin, saw a dramatic drop in the use of opioids post-operatively and in post-operative pain scores when it implemented an Enhanced Recovery After Surgery program for elective colorectal surgery patients. Because patients felt better and returned to ambulation sooner, the hospital reduced its average length of stay for these patients by one day. The hospital instituted a similar program with hip fracture patients and reduced the use of pain medication by 77 percent within the first 12 hours after surgery.
At Select Physicians Surgery Center in Tampa, Florida, a program called Non-Opioid Perioperative Engagement (NOPE!™) has helped limit the use of opioids following surgery and eliminated the use of the powerful opioid fentanyl in more than 2,000 patients undergoing head and neck surgery. For those patients who do receive opioids following surgery, they are going home with significantly fewer pills. In addition, many patients experience shorter post-acute care unit stays as well as less nausea and vomiting following surgery, which lowers the risk of unnecessary ER visits or hospital readmission.
Conclusion
MMPM and other opioid-sparing practices offer benefits to patients, healthcare providers and the broader community. They can improve clinical outcomes, prevent costly complications and reduce lengths of stay while limiting individuals’ exposure to opioids and decreasing the total number of prescriptions available for potential misuse.
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