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Analgesia and Pain Management

Analgesia and Pain Management

Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...

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Determining Pain Detection and Tolerance Thresholds Using an Integrated, Multi-Modal Pain Task Battery

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A Retrospective Study: Multimodal Analgesia Quality Measure Implementation and Patient Outcome Assessment.

Noah Lee¹, Jamie Feldt², Carrie Bowman³

¹Johns Hopkins Hospital, Baltimore, Maryland.

|November 21, 2023

Summary

Nonopioid multimodal analgesia, guided by Merit-based Incentive Payment System (MIPS) 477, reduced intraoperative opioid use and initial postoperative pain. However, it did not significantly impact discharge pain, overall opioid consumption, or postoperative nausea and vomiting.

Keywords:

MIPS 477 quality measure protocol multimodal analgesia pain score

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Area of Science:

Anesthesiology
Pain Management
Health Policy

Background:

Nonopioid multimodal analgesia is known to reduce opioid consumption and postoperative nausea and vomiting (PONV).
The impact of Merit-based Incentive Payment System (MIPS) 477 on patient outcomes has not been previously studied.

Purpose of the Study:

To evaluate patient outcomes following the implementation of MIPS 477 for nonopioid multimodal analgesia.
To assess the effect of MIPS 477 on postoperative pain, opioid consumption, and PONV in gynecological surgery patients.

Main Methods:

Retrospective review of 400 adult patients undergoing laparoscopic gynecological procedures.
Data collected included patient characteristics, analgesics, pain scores (PACU arrival and discharge), and antiemetics.
Comparison between a control group (n=29) and a treatment group (n=341) implementing MIPS 477.

Main Results:

The treatment group (MIPS 477) showed significantly lower pain scores upon PACU arrival (P = .001).
Total intraoperative opioid consumption (MMEs) was significantly reduced in the treatment group (P = .04).
No statistically significant differences were observed in PACU discharge pain scores, total PACU MMEs, or PONV between groups.

Conclusions:

Implementation of MIPS 477 for nonopioid multimodal analgesia effectively reduced initial postoperative pain and intraoperative opioid administration.
Further research is needed to optimize MIPS 477 protocols to address discharge pain, overall opioid use, and PONV.