b'Multimodal Use of Non-Opioid Painkillers Urged for Post-Surgical PatientsMinneapolis VA Researcher Led Many Pain Management ChangesBy Stephen SpotswoodMINNEAPOLISHow post-operative pain is treated has changed at the VA, as research has demonstrated that opioids and non-opioids work comparatively well when it comes to relieving pain, with non-opioids having less serious adverse effects and much lower chance of addiction. Much of this research has been under the guidance of Erin Krebs, MD, MPH, chief of general internal medicine at the Minneapolis VA and a professor of medicine at the University of Minnesota. Krebs has been focused on opioids and the over-reliance on them by physicians her entire medical career.I started medical school in 1996, the year thatErin Krebs, MD, MPHOxyContin was approved, Krebs explained. At first, in my med school lectures, I heard things like,Since then, Krebs has led numerous studies, including Opioids are best used only in short-term situations, or inones that show non-opioids treat pain just as well as opioids.hospitalization situations, or at end of life. But by the timeUntil recently there werent a lot of clinical trials I was in residency, we were doing things differently. I heard,between opioids and non-opioid medications, she No, we should use them for more problems. Its a matter ofexplained. Almost all of the trial tended to be these short-compassion. We dont want to ignore pain, so we want toterm placebo-controlled trials, and most pain meds work treat it more aggressively.better than placebo. What was lacking was comparison. These mixed messages made Krebs curious. WhatIn a ground-breaking study published in the March 2018 research had been done that had sparked this newissue of JAMA, Krebs detailed the results of the SPACE willingness to prescribe opioids more widely. Randomized Clinical Trial. The study, which recruited 240 I was surprised to see that there wasnt new dramaticveterans from the Minneapolis area, compared pain relief in scientific knowledge, she declared. It was related to newopioids with pain relief in acetaminophen and non-steroidal products being available.anti-inflammatory drugs (NSAIDS).1(meloxicaminjection),whichisindi- treatment is being used at VA hospitalsunderstandthefactorsthatinfluence cated for the management of moderateisntclear,witharecentstudyofaanesthesiologists choices. To do that, to severe pain, alone or in combinationsingle university-affiliated VA hospitalthey assessed the associations between with other non-NSAID analgesics. Thefinding the new technique for periop- patient or surgical characteristics and drug from Baudax Bio is the first once- erative pain management is being usedthenumberofnon-opioidanalge-per-day24-hour,intravenousCOX-2but could be improved. sicmodesreceivedintraoperatively preferential NSAID, the company said.ThereportinthejournalPainacross a variety of surgeries. 4It was approved based on phase 3 trialsMedicine noted that previous studiesIncluded were elective inpatient sur-in patients who had undergone bunio- havefoundsubstantialvariabilityingeriesorthopedic,thoracic,spine, nectomyandelectiveabdominoplastyitsutilization.Theauthorsfromtheabdominal and pelvic proceduresthat surgeries. VA Palo Alto Health Care System andusedatleastonenonopioidanalge-How widely multimodal post-operativeStanfordUniversitysoughttobettersicwithinaone-yearperiod.Results 202020 COMPENDIUM OF FEDERAL MEDICINE'