Preventing and Managing Chronic Post-Surgical Pain
Chronic postsurgical pain (CPSP) is a serious problem affecting millions of patients each year. The latest research estimates that between 10% and 30% of surgical patients experience persistent pain one year following their surgical procedure. Up to 5% of those patients experience severe, disabling pain one year following surgery.
Post-operative management is a key element in the development (or prevention) of CPSP – especially related to the patient’s transition from anesthesia to the ICU following surgery.
There are several risk factors that can lead to the development of CPSP. While we still lack thorough research to form a clear consensus on each risk factor, there is enough evidence to show a correlation between the following risk factors and CPSP.
Below are some of the known risk factors that occur before, during, and after surgery:
- Pre-existing pain syndromes such as low back pain, fibromyalgia, migraines, etc. (pre-operative)
- Lack of resilience and other similar psychological factors (pre-operative)
- Pre-operative pain in surgical site (pre-operative)
- Younger age and genetic components (pre-operative)
- Type of incision (intra-operative)
- Type of surgery (intra-operative)
- Nerve handling and injury (intra-operative)
- Use of chemotherapy or radiotherapy (post-operative)
- Disease recurrence at surgical site (post-operative)
- Acute post-operative pain (post-operative)
Although CPSP is not the single cause of the epidemic of opioid abuse in America, the two issues are related. Over 95% of patients are prescribed opioids following inpatient and outpatient surgical procedures. Of those patients who receive opioids following surgery, around 8% continue taking opioids one year following low-risk surgery and one in 15 of all surgical patients who receive opioids become long-term opioid users.
While there are ways to improve post-surgical pain management, the ideal approach is to prevent CPSP from occurring in the first place. A crucial preventative measure that is less common is avoiding the surgical procedure and seeking an alternative solution. However, this is not an option in many cases.
One of the most critical preventative measures is preventing nerve injury during surgery through the use of nerve-sparing techniques. Once a nerve is damaged, it triggers a sequence of inflammatory neuropathic mechanisms throughout the body. This variety of mechanisms makes it virtually impossible to manage all of the pain through a single therapeutic method or strategy.
Proper documentation is perhaps the best preventative measure that sometimes gets lost in the shuffle of surgery. Once a patient arrives in the ICU following surgery, the ICU nurses rely on the anesthesiologist’s documentation to form their pain management strategy. Sometimes an anesthesiologist will complete a patient’s chart pre-operation and then make slight adjustments to the patient’s sedation or pain management during surgery without updating the patient’s chart. Other details affecting the patient’s pain also might not make it to the patient’s chart, giving the ICU nurses inadequate information to work from.
Nurses’ Role in Pain Management
Communication between anesthesia and the ICU nurses is an important step in effective post-operative pain management. It’s much easier to prevent CPSP by ensuring pain is well-managed throughout the patient’s entire hospital stay. Once the pain passes a certain threshold, which is subjective to each patient, more medication is often required to lower that pain back to a tolerable level than would have been necessary to prevent the pain from reaching that threshold in the first place.
Effective management of the transfer procedure of patients from anesthesia to ICU following surgery is key to ICU pain management plans, thus enhancing the quality of care for patients. ICU nurses and CRNAs can do something for their patients by cooperating for improved communications between their respective departments, for effective pain management throughout the patients’ hospitalization period.
Elcam Medical helps ICU nurses and CRNAs manage pain more effectively through the use of innovative medical devices, such as the Marvelous Stopcock and Safe2 Rotator. These devices allow nurses to administer sedatives and pain medications through a needle-free injection site while preventing disconnections and air embolism.
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