By Annette M. Boyle
WASHINGTON—Since the rollout of the VA’s Opioid Safety Initiative in 2014, the department has aggressively focused on developing non-narcotic alternatives to reduce opioid use for chronic pain. Now, attention is turning to options that delay or reduce the need for opioids for pain related to diseases, such as cancer or following trauma or surgery.
A multimodal approach to treating pain has gained traction in the VA and DoD as the preferred approach to management of acute as well as chronic pain. Multimodal pain management combines several agents from different pharmacologic analgesic classes that affect different mechanisms in the pain pathway to achieve more-effective pain control with fewer adverse side effects. This technique can combine regional anesthesia or nerve blocks, nonopioid medications and complementary integrative health services.
Multimodal pain management techniques can help delay and reduce opioid use following a procedure or injury by harnessing the synergistic action of multiple agents. The approach might also enable patients to avoid the complications of opioid-based analgesia, which include delayed recovery, hypoventilation, atelectasis, nausea, vomiting, urinary retention, pruritus, prolonged ileus, dizziness and confusion, according to Leopoldo Rodriguez, MD, a director of the Society for Ambulatory Anesthesia.