How cold and compression therapy is improving patient outcomes and reducing the need for narcotics

When it comes to orthopedic surgery, two of patients’ most important questions are how long their recovery will be and how much pain they will experience. When addressing postoperative pain, physicians today are reluctant to include opioids in pain management protocols and patients are reluctant to take them.

Fortunately, new and safer options are now available for pain management. Becker’s Healthcare recently spoke with two pain management experts about how cold and compression therapy is improving patient outcomes and reducing the need for narcotics, both pre- and post-surgery, as well as in the physical therapy setting:

  • Dan Guttmann, MD, director of Taos (N.M.) Orthopedic Institute in Taos
  • Alek Johnson, manager of cast room and durable medical equipment (DME) services, Midwest Orthopaedics at Rush (MOR), in Chicago

Motorized cold therapy with active compression offers safe, effective and affordable post-surgical pain relief

Before and after orthopedic procedures, pain and swelling are common symptoms. This is particularly true with arthroscopic surgery, where surgeons must pump fluid into the shoulder or knee to see the work they need to do. After the procedure is finished, the joint is often very swollen.

Simply applying cold alone isn’t as effective as applying both cold and compression. Until recently, however, access to motorized cold therapy with active compression was limited to elite athletes. As this technology has evolved, however, the price of devices has come down significantly. This is good news for patients and clinicians alike.

Dr. Guttmann specializes in shoulder and elbow surgeries. “Given the problem of opioid addiction in recent years, we are constantly looking for alternatives to help people with their pain,” he said. “Almost every patient who has used motorized cold therapy with compression has said they are so glad they did. Many patients say they hardly needed any narcotics or anti-inflammatories at all. They also say that the ice is easy to use. It has made a huge difference in their pain and recovery and limited their need for medications.”

Midwest Orthopaedics at Rush has had similar experiences. “Where we are seeing cold and compression really make an impact in DME overall is during the first part of a patient’s recovery,” Mr. Johnson said. “That’s when you would expect usage of pain medicine to be the highest. With Breg’s Polar Care WaveTM, both the temperature and the compression can be controlled. It’s definitely reduced the amount of medication that patients need immediately after surgery.”

For surgeons like Dr. Guttmann, this is very encouraging. “There are very few drugs that don’t have some potential side effects,” he said. “We’ve learned the hard way that even short-term usage of narcotics can be problematic. Drugs that are seemingly benign like ibuprofen and aspirin can also have problems. When I tell patients that they won’t need narcotics as much or maybe at all after surgery, they really embrace that. The fewer medications a patient has to take, the better off they are.”

Cold and compression therapy is also beneficial prior to surgery and for nonoperative patients

While cold and compression therapy has been a game changer postoperatively, it can also play an important role prior to surgery. “I now give cold and compression therapy to patients who are scheduling surgery,” Dr. Guttmann said. “I want them to do some rehab before their procedure, but I don’t want them hooked on narcotics. There is a lot of literature that shows people who use opioids before surgery don’t do as well postoperatively. If you can minimize the use of narcotics preoperatively and use devices like Polar Care Wave, it really helps patients have a safer and faster recovery, and more predictable outcomes.”

One of the benefits of using cold and compression therapy preoperatively is that patients become familiar with using it. “There aren’t a lot of bells and whistles with the Wave device. It has a good track record in terms of reliability and ease of use,” Dr. Guttmann said. Polar Care Wave is also very portable. Dr. Guttmann asks his patients to bring the device with them on the day of surgery, since that is when the most swelling occurs.

Dr. Guttman has also turned to cold and compression therapy for patients who may not need surgery, but are struggling with physical therapy. “To participate in therapy, you can’t be suffering from a lot of pain,” he said. “We are always looking for solutions which will allow patients to participate more consistently in rehab, like injections, medications or other things to augment pain relief. There’s definitely an indication for using Wave as a nonoperative treatment.”

Similarly, Midwest Orthopaedics at Rush has expanded the use of Polar Care Wave to its PT locations. “Patients in the PT setting like compression ice therapy so much that we have Wave available for them to purchase,” Mr. Johnson said. “We’ve seen significant sales of the device.”

Patients appreciate cold and compression therapy devices designed for usability

Before cold and compression therapy was widely available, orthopedic practices offered patients other pain management solutions postoperatively, such as gravity-based compression devices.

Mr. Johnson has worked at Midwest Orthopaedics at Rush since 2017 and has been the manager of the cast room and DME services for about a year. “When I first came into this role, we were using gravity-based compression devices,” he said. “These weren’t very user-friendly for many of our patients, especially Baby Boomers. Gravity-based compression machines have to be lifted and placed on a higher level in order for gravity to work. After knee surgery, that’s difficult — especially for people who live alone.”

One of Mr. Johnson’s first tasks as manager of the cast room and DME services was to evaluate MOR’s ice and cold therapy program. “I took a leap of faith with Polar Care Wave and we’ve seen usage expand significantly. The doctors all use it frequently and it’s done very well for us overall,” he said.

Thus far, patient feedback about the Polar Care Wave device has been very good. As Mr. Johnson explained, “There are only two buttons to activate the unit. There are two levels of cold and two levels of compression. Patients can run them both at the same time or separately with the two buttons.”

In addition, patients appreciate that Polar Care Wave offers attachments designed for specific body parts. “We do a lot of knees, hips and shoulders,” Mr. Johnson said. “The hip attachment, for example, goes all the way down to the mid-portion of the knee, but it also wraps around the patient’s waist, so there is complete coverage around the entire joint. The same approach is used for knees and shoulders. The attachment wraps entirely around the knee and the shoulder attachment covers the entire first portion of the arm. Some patients have come back and purchased additional attachments for the unit.”

Based on the positive feedback that Dr. Guttman has received about cold and compression therapy, he has asked patients to record testimonials about their experiences. “Most people don’t have elective surgery more than once or twice in their lifetimes, so many patients are fairly anxious,” he said. “Testimonials from people who have used Wave give prospective patients greater confidence that options exist to reduce their postoperative pain.”

Conclusion

Motorized cold therapy with active compression enables patients to benefit from two therapies in the comfort of their homes. “At its price point, nothing rivals Polar Care Wave in terms of effectiveness,” Mr. Johnson said. “Patients can maximize their recovery by applying compression and ice on the joint whenever they need it.”

Dr. Guttmann also underscored the value of a pain management protocol that reduces the need for opioids and other drugs. “It’s hard to see a patient in pain and not have an answer for them,” he said. “Anything we can do to minimize the use of narcotics is better for the patient, better for their outcomes and better for our culture. The goal of surgery is to provide people with a better quality of life. I’ve seen several hundred patients now with cold and compression therapy and I feel it’s almost an essential adjunct to any postoperative or perioperative treatment.”

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