Pain Management
P re f a c e Pain Management
Catherine Curtin, MD
This issue of Hand Clinics is devoted to the subject of pain. For surgeons, pain is a common theme in patient care and can be a frustrating area of practice. Pain is a subjective experience that cannot be externally evaluated, so the health care provider has no ability to quantitatively assess the pain or its response to treatment. The subjective nature of pain can leave the provider feeling uncertain on next steps, especially when the patient complains of pain even though the tissue injury has healed. With experience, it becomes clear that refilling narcotics is not the solution for these pain patients. Yet other potential treatment options often are unfamiliar or seem to be in the domain of other disciplines. Thus, the surgeon can be stuck waiting on the availability of a pain doctor or bogged down in insurance delays before their patient gets the appropriate treatments. This issue of Hand Clinics does not want to make hand surgeons into pain physicians. However, the goal is to provide hand surgeons with more information and tools. Then, surgeons can ensure their patients with pain get timely and appropriate care. A hand surgeon with knowledge of the field of pain management can quickly initiate treatment and direct the patient to the most appropriate outside providers. This overview of pain and its treatment is particularly timely as pain management is increasingly part of public discourse and heath policy goals.1,2 Appropriate pain management is linked to qualityof-care initiatives and is a Joint Commission Standard. Pain treatment is strongly associated with patient satisfaction.3,4 Poor pain control increases the likelihood of unplanned return to care, such as
an emergency visit or readmission to the hospital. For example, we found that after distal radius fracture treatment, pain was a common cause of unplanned return to care.5 These negative results from inadequate pain control (readmissions and decreased patient satisfaction) are now increasingly linked to financial penalties, which means that for surgeons improving pain control is not just a humanistic goal but an economic one. Yet there are also countervailing pressures in pain management to decrease the reliance on opioids due to an epidemic of abuse of prescription medications.6 Surgeons are caught in the middle of these forces, trying to provide adequate patient care but not contribute to inappropriate use of opioid medications. Thus, for surgeons who both cause and treat pain, it is critical to understand the many different facets of pain and its treatment. One reason that pain care is challenging for surgeons is that most educational tools, research, and information are found outside the field of hand surgery. These other fields (mostly anesthesia) have extensively studied pain and found that a high and surprisingly consistent number of people have prolonged pain after surgery (about 20% regardless of the surgery).7 This prolonged pain is often thought to be of neuropathic origin.8 This Hand Clinics issue discusses pain with a focus on neuropathic pain and includes information from a wide array of experts from different disciplines. The issue reviews the impact of pain on hand function and looks at risk factors associated with the development of persistent pathologic pain. This Hand Clinics issue presents a broad review of treatment options, including psychological,
Hand Clin 32 (2016) ix–x http://dx.doi.org/10.1016/j.hcl.2015.09.001 0749-0712/16/$ – see front matter Ó 2016 Published by Elsevier Inc.
hand.theclinics.com
Editor
x
Preface physical therapy, medication, nerve stimulation, and surgical interventions. I hope that the information in this issue of Hand Clinics will provide hand surgeons with more information on familiar treatments and new strategies to use to treat their patients with pain. With a complete armamentarium, pain treatment can go from the most frustrating to a highly satisfying part of your practice. There are no patients more grateful than those you help with their pain. Catherine Curtin, MD Palo Alto Veterans Hospital and Stanford University Suite 400, 770 Welch Road Palo Alto, CA 94304, USA E-mail address: [email protected]
REFERENCES 1. Sifferlin A. The problem with treating pain in America. TIME. Available at: http://time.com/3663907/treatingpain-opioids-painkillers/. Accessed August 1, 2015.
2. IOM Report. Relieving pain in America. Available at: http://iprcc.nih.gov/docs/032712_mtg_presentations/ IOM_Pain_Report_508comp.pdf. Accessed August 7, 2015. 3. Hanna MN, Gonza´lez-Ferna´ndez M, Barrett AD, et al. Does patient perception of pain control affect patient satisfaction across surgical units in a tertiary teaching hospital? Am J Med Qual 2012;27(5):411–6. 4. Maher DP, Wong W, Woo P, et al. Perioperative factors associated with HCAHPS responses of 2,758 surgical patients. Pain Med 2015;16(4):791–801. 5. Curtin CM, Hernandez-Boussard T. Readmissions after treatment of distal radius fractures. J Hand Surg Am 2014;39(10):1926–32. 6. Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13–4795. Rockville (MD): Substance Abuse and Mental Health Services Administration; 2013. 7. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet 2006; 367(9522):1618–25. 8. Shipton E. Post-surgical neuropathic pain. ANZ J Surg 2008;78(7):548–55.
P re f a c e Pain Management
Catherine Curtin, MD
This issue of Hand Clinics is devoted to the subject of pain. For surgeons, pain is a common theme in patient care and can be a frustrating area of practice. Pain is a subjective experience that cannot be externally evaluated, so the health care provider has no ability to quantitatively assess the pain or its response to treatment. The subjective nature of pain can leave the provider feeling uncertain on next steps, especially when the patient complains of pain even though the tissue injury has healed. With experience, it becomes clear that refilling narcotics is not the solution for these pain patients. Yet other potential treatment options often are unfamiliar or seem to be in the domain of other disciplines. Thus, the surgeon can be stuck waiting on the availability of a pain doctor or bogged down in insurance delays before their patient gets the appropriate treatments. This issue of Hand Clinics does not want to make hand surgeons into pain physicians. However, the goal is to provide hand surgeons with more information and tools. Then, surgeons can ensure their patients with pain get timely and appropriate care. A hand surgeon with knowledge of the field of pain management can quickly initiate treatment and direct the patient to the most appropriate outside providers. This overview of pain and its treatment is particularly timely as pain management is increasingly part of public discourse and heath policy goals.1,2 Appropriate pain management is linked to qualityof-care initiatives and is a Joint Commission Standard. Pain treatment is strongly associated with patient satisfaction.3,4 Poor pain control increases the likelihood of unplanned return to care, such as
an emergency visit or readmission to the hospital. For example, we found that after distal radius fracture treatment, pain was a common cause of unplanned return to care.5 These negative results from inadequate pain control (readmissions and decreased patient satisfaction) are now increasingly linked to financial penalties, which means that for surgeons improving pain control is not just a humanistic goal but an economic one. Yet there are also countervailing pressures in pain management to decrease the reliance on opioids due to an epidemic of abuse of prescription medications.6 Surgeons are caught in the middle of these forces, trying to provide adequate patient care but not contribute to inappropriate use of opioid medications. Thus, for surgeons who both cause and treat pain, it is critical to understand the many different facets of pain and its treatment. One reason that pain care is challenging for surgeons is that most educational tools, research, and information are found outside the field of hand surgery. These other fields (mostly anesthesia) have extensively studied pain and found that a high and surprisingly consistent number of people have prolonged pain after surgery (about 20% regardless of the surgery).7 This prolonged pain is often thought to be of neuropathic origin.8 This Hand Clinics issue discusses pain with a focus on neuropathic pain and includes information from a wide array of experts from different disciplines. The issue reviews the impact of pain on hand function and looks at risk factors associated with the development of persistent pathologic pain. This Hand Clinics issue presents a broad review of treatment options, including psychological,
Hand Clin 32 (2016) ix–x http://dx.doi.org/10.1016/j.hcl.2015.09.001 0749-0712/16/$ – see front matter Ó 2016 Published by Elsevier Inc.
hand.theclinics.com
Editor
x
Preface physical therapy, medication, nerve stimulation, and surgical interventions. I hope that the information in this issue of Hand Clinics will provide hand surgeons with more information on familiar treatments and new strategies to use to treat their patients with pain. With a complete armamentarium, pain treatment can go from the most frustrating to a highly satisfying part of your practice. There are no patients more grateful than those you help with their pain. Catherine Curtin, MD Palo Alto Veterans Hospital and Stanford University Suite 400, 770 Welch Road Palo Alto, CA 94304, USA E-mail address: [email protected]
REFERENCES 1. Sifferlin A. The problem with treating pain in America. TIME. Available at: http://time.com/3663907/treatingpain-opioids-painkillers/. Accessed August 1, 2015.
2. IOM Report. Relieving pain in America. Available at: http://iprcc.nih.gov/docs/032712_mtg_presentations/ IOM_Pain_Report_508comp.pdf. Accessed August 7, 2015. 3. Hanna MN, Gonza´lez-Ferna´ndez M, Barrett AD, et al. Does patient perception of pain control affect patient satisfaction across surgical units in a tertiary teaching hospital? Am J Med Qual 2012;27(5):411–6. 4. Maher DP, Wong W, Woo P, et al. Perioperative factors associated with HCAHPS responses of 2,758 surgical patients. Pain Med 2015;16(4):791–801. 5. Curtin CM, Hernandez-Boussard T. Readmissions after treatment of distal radius fractures. J Hand Surg Am 2014;39(10):1926–32. 6. Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13–4795. Rockville (MD): Substance Abuse and Mental Health Services Administration; 2013. 7. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet 2006; 367(9522):1618–25. 8. Shipton E. Post-surgical neuropathic pain. ANZ J Surg 2008;78(7):548–55.
