b'Multimodal Use of Non-Opioid Painkillers Urged for Postsurgical PatientsThe study found that, for chronic pain, the two types ofWhat I think is really exciting are the advances in drugs worked equally well for pain relief, with adverse effectsanesthesia to do local pain blocks, Krebs said. People being significantly more common in the opioid group. need far fewer medications overall in the period right [This study] was for chronic long-term pain, but otheraround surgery. Which is great. When people are trying investigators have similarly done trials comparing opioidto recover, they want to be able to get up and get and other medications for acute and short-term pain,going without all the grogginess and side effects that Krebs said. The pretty consistent finding is that it seemsmedications cause. opioids arent better in most cases for relieving pain. TheNew research has also found that there is an upper other tools are just as good.limit to the amount of pain that can be relieved, especially perioperatively. Abrupt Adjustment We need to do a better job of informing patients what VA has moved quickly to adapt to the changingto expect after surgery, Krebs noted. [Teach them] to use recommendations for opioid prescribing, though its beentheir pain to guide their activity, and what they can do if an exceptionally abrupt adjustment for physicians. they have difficulty with pain. For practicing clinicians and patients, it almostPain management, she noted, is never one-size-fits-all. seemed like it was overnight we did a complete 180 onAnd the challenge is not in developing new drugs, but in the guidance, Krebs noted. The rationale for changingbetter understanding pain and how to combine current guidance has been building, but for many people whotherapies to the benefit of individual patients. werent looking at those data every day, it seemed extremelyWhether its long-term pain or short-term pain, sudden. Usually changes in medicine are more gradual andcombining treatment is probably the best path to people have time to adapt. That wasnt the case here.treatment, Krebs explained. Were just starting to Today VAs pain management guidelines list opioids asunderstand that. a drug of last resort in managing perioperative pain. Non- 1 Krebs EE, Gravely A, Nugent S, et al. Effect of Opioid vs Nonopioid pharmacological and non-opioid medications are preferred, withMedications on Pain-Related Function in Patients With Chronic Back acetaminophen and topical and oral NSAIDs topping the list.Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial. JAMA. 2018;319(9):872-882. doi:10.1001/jama.2018.0899Meanwhile the research base for pain management is growing alongside the medical advances. indicated that, of the 1,087 procedures1Hernandez-Boussard T, Graham LA, Carroll I,Updated Report by the American Society of identified,33%,53%,and14%wereet al. Perioperative opioid use and pain-relatedAnesthesiologists Task Force on Acute Pain managedwithone,twoandthreeoroutcomes in the Veterans Health Administra- Management. Anesthesiology 2012;116(2):248-tion [published online ahead of print, 2019 Jun273. doi: https://doi.org/10.1097/more modes, respectively. 28]. Am J Surg. 2019;S0002-9610(19)30581-1.ALN.0b013e31823c1030.The study found that older patients haddoi:10.1016/j.amjsurg.2019.06.022loweroddsofreceivingthreeormore2 4Kwong JZ, Mudumbai SC, Hernandez-Bous- Shadbolt C, Abbott JH, Camacho X, et al. Thesard T, Popat RA, Mariano ER. Practice Pat-modes (adjusted odds ratio [aOR] = 0.28,Surgeons Role in the Opioid Crisis: A Nar- terns in Perioperative Nonopioid Analgesic Ad-95%confidenceinterval[CI]=0.15- rative Review and Call to Action. Front Surg.ministration by Anesthesiologists in a Veterans 0.52), as were patients with more comor- 2020;7:4. Published 2020 Feb 18. doi:10.3389/ Affairs Hospital. Pain Med. 2020;21(2):e208-bidities (two modes: aOR = 0.87, 95% CIfsurg.2020.00004 e214. doi:10.1093/pm/pnz226= 0.79-0.96; three or more modes: aOR =3Practice Guidelines for Acute Pain Man-0.81, 95% CI = 0.71-0.94).agement in the Perioperative Setting: An 2020 COMPENDIUM OF FEDERAL MEDICINE 21'