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Current Pain and Headache Reports
Published in: Current Pain and Headache Reports 1/2017

01-01-2017 | Other Pain (N Vadivelu and A Kaye, Section Editors)

Concept of the Ambulatory Pain Physician

Authors: Donna-Ann Thomas, Daniel Chang, Richard Zhu, Hassan Rayaz, Nalini Vadivelu

Published in: Current Pain and Headache Reports | Issue 1/2017

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Abstract

Purpose of Review

Given the growing number of ambulatory surgeries being performed and the variability in postoperative pain requirements, early discharge, and inconsistent follow-up, ambulatory surgery presents a unique challenge for this patient population and warrants the presence of an ambulatory pain specialist to evaluate a patient preoperatively and postoperatively to optimize patient safety and satisfaction. This article explores the crucial role that a dedicated pain physician would have in the ambulatory surgery setting.

Recent Findings

The prevalence of chronic pain, opioid use, and substance abuse is growing in this country, while ambulatory and same-day surgery have also experienced considerable growth. Inevitably, more patients with challenging chronic pain or substance abuse are having ambulatory surgery. Increased BMI, advanced age, more comorbidities warranting a higher ASA physical status classification, and longer surgeries are now all components of ambulatory surgery that contribute to increased risk too. Certain surgeries including breast surgery, inguinal hernia repair, and thoracotomy are at higher risk for the conversion of acute to chronic pain, and an ambulatory pain specialist would be beneficial for added focus on these patients.

Summary

Multimodal pain control with non-opioids and regional anesthesia adjuvants are beneficial, while emphasis on a patient’s functional capacity may be more useful than quantifying the severity of pain. Despite the best efforts of patients’ primary care providers or surgeons, patients often are discharged with more chronic opioid therapy than they presented with, and an ambulatory pain specialist can help manage the complications and prevent further escalation of this opioid epidemic. An onsite anesthesiologist with interest in pain management in each ambulatory surgery center administering anesthesia and available onsite to deal with immediate preoperative, intraoperative, and recovery room would be ideal to curb and manage complication from uncontrolled pain and related pain issues.
Literature
1.
2.
Trescot AM et al. Opioid guidelines in the management of chronic non-cancer pain. Pain Physician. 2006;9(1):1–39.PubMed
3.
• Manchikanti L et al. Therapeutic use, abuse, and nonmedical use of opioids: a ten-year perspective. Pain Physician. 2010;13(5):401–35. Documents recent data regarding prevalence of pain in the US.PubMed
4.
Rapp SE, Ready LB, Nessly ML. Acute pain management in patients with prior opioid consumption: a case-controlled retrospective review. Pain. 1995;61(2):195–201.CrossRefPubMed
5.
Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. Natl Health Stat Report. 2009;11:1–25.
6.
Apfelbaum JL et al. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97(2):534–40. table of contents.CrossRefPubMed
7.
Apfel C et al. Effect of i.v. acetaminophen on total hip or knee replacement surgery: a case-matched evaluation of a national patient database. Am J Health Syst Pharm. 2015;72(22):1961–8.CrossRefPubMed
8.
Hadzic A et al. For outpatient rotator cuff surgery, nerve block anesthesia provides superior same-day recovery over general anesthesia. Anesthesiology. 2005;102(5):1001–7.CrossRefPubMed
9.
Liu SS et al. A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials. Anesth Analg. 2005;101(6):1634–42.CrossRefPubMed
10.
Pavlin DJ et al. A survey of pain and other symptoms that affect the recovery process after discharge from an ambulatory surgery unit. J Clin Anesth. 2004;16(3):200–6.CrossRefPubMed
11.
Rana MV et al. Perioperative pain control in the ambulatory setting. Curr Pain Headache Rep. 2016;20(3):18.CrossRefPubMed
12.
13.
14.
McGrath B, Chung F. Postoperative recovery and discharge. Anesthesiol Clin North America. 2003;21(2):367–86.CrossRefPubMed
15.
Whippey A et al. Predictors of unanticipated admission following ambulatory surgery: a retrospective case-control study. Can J Anaesth. 2013;60(7):675–83.CrossRefPubMed
16.
Golembiewski J. Evolving Role of Local Anesthetics in Managing Postsurgical Analgesia. Clin Ther. 2015;37(6):1354–71.CrossRefPubMed
17.
• Benzon H, editor. Essentials of Pain Medicine. 3rd ed. Philadelphia: Elsevier; 2011. Overview of importance of multi-modal analgesia.
18.
Benzon HT. Practical Management of Pain. 5th ed. Philadelphia: Elsevier; 2014.
19.
Dickerson D. Acute pain management. Anesthesiology Clin. 2014;32(2):495–504.CrossRef
20.
•• Taskforce A. Practice guidelines for acute pain management in perioperative Setting. Anesthesiology. 2012;116(2):248–73. Explores the importance of effective pain management in the peri-operative setting with the goal of optimally managing these patients in order to limit any unnecessary escalation of care.CrossRef
21.
22.
Calcaterra SL et al. Opioid prescribing at hospital discharge contributes to chronic opioid use. J Gen Intern Med. 2016;31(5):478–85.CrossRefPubMed
23.
Ringwalt C et al. Differential prescribing of opioid analgesics according to physician specialty for Medicaid patients with chronic noncancer pain diagnoses. Pain Res Manag. 2014;19(4):179–85.CrossRefPubMedPubMedCentral
24.
25.
Blitz JD et al. Preoperative evaluation clinic visit is associated with decreased risk of in-hospital postoperative mortality. Anesthesiology. 2016;125(2):280–94.CrossRefPubMed
26.
Frei-Jones MJ, Field JJ, DeBaun MR. Multi-modal intervention and prospective implementation of standardized sickle cell pain admission orders reduces 30-day readmission rate. Pediatr Blood Cancer. 2009;53(3):401–5.CrossRefPubMedPubMedCentral
Metadata
Title
Concept of the Ambulatory Pain Physician
Authors
Donna-Ann Thomas
Daniel Chang
Richard Zhu
Hassan Rayaz
Nalini Vadivelu
Publication date
01-01-2017
Publisher
Springer US
Published in
Current Pain and Headache Reports / Issue 1/2017
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-017-0611-2

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