Non-Opiate Pain Relief Methods to Consider
by Rynae Golke
If you’re in healthcare administration and your facility has an emergency department, pain management clinic, or primary care clinic, this course is for you. Your doctors are being pressured by patients every day to prescribe pain killers for what may truly be severe and chronic pain. Every day, many times a day, they decide between perpetuating the opioid epidemic and leaving a patient to suffer, decisions which ultimately lead to physician burnout.
Your docs need your help. They can’t bring in innovative solutions unless the facility is willing to invest in change and improvement. They need you to go to bat for them, to understand their deep concern, and to care as much as they care. There were 52,404 deaths related to opioid overdose in 2015 alone according to the American Society of Addiction Medicine, a statistic that should speak volumes to healthcare professionals and inspire immediate change.
This case study is a perfect example of the challenge ER doctors face every day:
“Dr. Nguyen is an ER physician in a busy emergency department. He is responsible for several patients at once tonight. Patient #1 may have a perforated bowel, patient #2 has chest pain and elevated cardiac enzymes, and patient #3 has severe, chronic back pain. In addition, a trauma patient is in transport and there are no open beds.
Dr. Nguyen knows that there is nothing he can do for the patient with back pain right now, and if he prescribes a painkiller for her, she will be discharged from the ED and the bed can be used for the trauma patient. He prescribes Fentanyl and discharges the patient with instructions to follow up with her primary care provider.
During his next shift, Dr. Nguyen treats a patient suffering from severe dental pain. Because he’s been under pressure to prescribe fewer narcotics, and because he suspects the patient may be drug-seeking, he refrains from prescribing a painkiller and refers the patient to a local dentist. The patient is back in the ED the next day, very emotionally distraught. Her face has swelled, she is in excruciating pain, and the only dentist she could reach on the weekend will not be in the office until Monday.”
The glaring problem in these scenarios is that Dr. Nguyen has no resources to alleviate the patient’s pain right now except opioid painkillers, leaving him to choose between alleviating the patient’s pain at a cost (risk of addiction) and leaving the patient to suffer. No good doctor is satisfied with either outcome.
The simple solution – easier said than done – is to provide ongoing training on non-narcotic pain relief and give your ER docs access to the services and resources their patients need.
Application of a heat wrap or heating pad to an area of pain can increase blood flow and relax the muscles to alleviate pain and discomfort. A hot bath can provide the same relief.
The application of cold packs can decrease blood flow to the area to reduce swelling, ease pain, and limit the nerves’ ability to send pain messages to the brain.
Massage therapy can ease pain for as long as six months, according to a study published in the Annals of Internal Medicine. Deep tissue can address some of the underlying muscular problems while more gentle techniques can provide relaxation and ease chronic soreness and pain.
Acupuncture uses tiny needles to treat chronic pain.
Physical therapy combines techniques like ice massage and ultrasound to provide immediate pain relief with education and exercise for long-term improvement of the underlying problem. Research shows that physical therapy is more effective in treating neck pain than medication.
Depression, stress, and anxiety can cause and exacerbate chronic pain. When patients have help managing their feelings and thoughts, they can experience physical benefits, like prevention and alleviation of pain, too.
How to accomplish it
There are as many ways to provide these solutions as there are solutions. The initiative has to start at the top, with hospital administration, and has to be accompanied by an investment in patient safety and risk management. The problem your doctors face is that there’s only one way to treat pain in the ER and even clinic at times. The solution is to provide them with more opportunities. Now, here are some arrangements that might work for your facility.
Add a pain relief team
You can provide your doctors with immediate solutions for their patients by adding a pain relief team to your emergency department. Team members to consider include a massage therapist, a dentist, a physical therapist, an acupuncturist, and a chiropractor. New or rural programs might be smaller and consist of a single pain relief nurse trained in massage and other safe pain relief methods like application of heat and cold, topical analgesics, and stretches. Depending on the size of your ER and number of patients who seek treatment for pain, this team can be an on-call team or a full-time, in-house team.
This relieves both the doctor and the patient and ensures no patient gets treated like a drug seeker, but that all patients are taken seriously and provided with reasonable pain relief. Furthermore, it decreases the number of drug seekers who seek treatment in your emergency department.
Partner with local professionals
A smaller scale solution may be to partner with local physical therapists, massage therapists, chiropractors, dentists, and acupuncturists, who – in exchange for your referrals – agree to provide after-hours care in emergencies. This allows physicians to connect a patient with the solution immediately.
If the administration team supports and facilitates the efforts, its doctors will follow.