Not the Same Old Thing: Emerging Trends in Pain Management

Some emerging trends in acute pain management are multimodal analgesia and trying to combine different medications or modalities to treat the cause of pain. We are in an opioid crisis, and opioids are a very strong pain medication and very necessary. But in patients who have acute inflammatory pain, or maybe acute neuropathic pain, opioids are not necessarily the first line treatment because they actually don’t really treat the cause of pain. But if there is inflammation or there is a neuropathic component, there are new medications or new ideas about how we can actually treat the source of pain. So combining different medications that alone may not provide adequate analgesia, but together through synergy can really drive pain down is a nice approach. In that way we can avoid some of the opioids in patients who are not taking them and why would we want to expose them to something that potentially has a risk of dependency if we can get them out of pain without it. The goal is to perform an intervention or combine a short course of medications to prevent the progression of chronic pain. A major initiative right now is to keep patients opiate naïve if they’re presenting to us opiate naïve. We know when we prescribe insulin or Coumadin we have lengthy conversations with patients about the risks, morbidity, and mortality. We’re prescribing very strong medications. And when we’re giving opioids, I think there’s a lack of an understanding about the strength or significance of what we’re prescribing, and certainly there’s not a focus on education. If you’re going to prescribe the opiate, you really must do the appropriate education.