Sweet Relief: Acute Pain Management for the Hospitalist-Slides

Slides
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The presentation "Sweet Relief: Acute Pain Management for the Hospitalist" by Drs. Theresa Vettese and Jung Mi Park provides a comprehensive, evidence-based guide for managing acute pain in hospitalized patients, emphasizing multimodal analgesia and safe opioid use.<br /><br />Key objectives include developing multimodal analgesic plans incorporating both opioid and non-opioid treatments, safely managing acute pain in opioid-dependent patients, and effective patient communication regarding pain and pain management.<br /><br />The presentation uses clinical case scenarios to illustrate pain management strategies: <br /><br />1. Transitioning from IV to oral opioids at hospital discharge, emphasizing a balanced plan with a 3–5 day opioid taper and integration of non-opioid treatments.<br />2. Non-opioid pharmacologic agents in the analgesic “toolbox” including NSAIDs, IV acetaminophen, topical agents, ketamine, and gabapentinoids. NSAIDs are highlighted for effectiveness and safety in acute pain but require caution in patients with GI, cardiovascular, or renal risks. Gabapentinoids lack robust evidence for acute pain and pose risks, suggesting cautious use.<br />3. Managing acute pain in patients with chronic pain on long-term opioids, involving careful continuation of baseline opioids, avoidance of IV opioids unless necessary, and emphasis on communication to set realistic expectations.<br />4. Pain management in sickle cell disease acute painful episodes, emphasizing continuation of baseline opioids plus around-the-clock opioid dosing often via PCA, plus NSAIDs, topical treatments, and supportive care.<br />5. Cancer pain management involves opioids titrated aggressively for relief, multimodal agents including neuroleptics, bisphosphonates, radiation, and interventional nerve blocks. Coordination of discharge opioid plans and naloxone provision is essential.<br />6. Acute pain in opioid use disorder patients requires continuation of opioid agonist therapy (methadone or buprenorphine) combined with additional short-acting opioids as needed, focusing on adequate analgesia without fear of relapse, plus linked treatment and harm-reduction strategies post-discharge.<br /><br />Overall, the presentation stresses the importance of multimodal pain management, minimizing opioid risks through thoughtful prescribing, monitoring, patient education, and careful discharge planning. Hospitalists should communicate pain goals effectively, tailor analgesics to patient history and risks, and coordinate continuity of care to optimize pain relief and safety.
Keywords
acute pain management
hospitalist
multimodal analgesia
opioid tapering
non-opioid analgesics
opioid-dependent patients
sickle cell pain
cancer pain management
opioid use disorder
patient communication