Features  |   July 2018
Postoperative Pain and Quality of Recovery: Adequate Functional Analgesia – the New Goal?
Article Information
Pain Medicine / Features
Features   |   July 2018
Postoperative Pain and Quality of Recovery: Adequate Functional Analgesia – the New Goal?
ASA Monitor 7 2018, Vol.82, 20-22.
ASA Monitor 7 2018, Vol.82, 20-22.
The presence of severe or uncontrolled pain after surgery has a negative impact not only on the quality of postoperative recovery but also on the occurrence of persistent or chronic pain. In early 2000, with reports of inadequately treated pain, The Joint Commission introduced the “pain as the fifth vital sign” initiative.1  In response, many institutions implemented pain therapy guided by pain scores (e.g., achieve pain scores of less than 4/10). It is most likely that such mandates have led to over-prescription of opioids and opioid-related morbidity and mortality.2,3  Nevertheless, the Centers for Medicare & Medicaid Services (CMS) considered pain management as part of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Fortunately, in 2017 CMS announced the removal of pain management dimension from HCAHPS.4  It was argued that reporting of inpatient pain assessment, as part of patient satisfaction, had unwanted consequences, including the opioid crisis that has besieged the U.S.5  In an effort to address the opioid crisis, the Drug Enforcement Administration in 2018 mandated a 20 percent reduction in the manufacture of opioid medications.6  In addition, there is a campaign to limit the duration of opioid prescription after discharge from the surgical facility (e.g., five to seven days after surgery). Such mandates will change the manner in which opioids are prescribed to treat acute postoperative pain, which may leave some patients without adequate pain relief. In fact, there is an acute shortage of intravenous morphine and other long-acting opioids, resulting in significant problems in managing pain after major surgery. Thus, the pendulum swings to another extreme. History suggests that government mandates, although with good intentions, may not work and might have significant unintended consequences. Thus, it is our responsibility to educate the decision-makers for which we require critical analysis of the problem and a balanced approach to address the issue.
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