OPIOIDS
62
Treasure Coast Medical Report
Examining a patient’s
chart are Martin
Health System’s pain
management team
members Dr. Amit
Asopa, Dr. Zackary
Boomsaad and Dr.
Alexander DeBonet.
days instead of staying up to a month. “Patients participate
earlier in their own care,” Grichnik states. “If you are not sick
to your stomach and are comfortable, you can get up, walk
around and have physical therapy. Deep breathing helps prevent
pneumonia and blood clots. Wounds don’t hurt as much
and patients are going home in a few days when they might
have been in the hospital for 30 days.”
The euphoria resulting from opioids may lead to dangerous
consequences. “Most seriously, if you take too much
opioid (medicine), you don’t want to breathe,” says Grichnik.
“The body metabolizes drugs and people become tolerant to
the medication. We don’t want patients to get to the point of
taking an opioid for a euphoric feeling instead of to relieve
pain. Targeted multimodal analgesia and ERAS programs
are a win, win, win for everyone. We champion this work
because it is so important to the patients.”
After a hip replacement operation at IRMC in July, Marion
White was home a day later and walking around. “It was
amazing,” declares White, a 70-year-old math teacher and tutor.
“I walked the day of the surgery, but I have taken nothing
stronger than Tylenol. I got a prescription filled for pain pills
but never used it.”
Martin Health System in Stuart has a pain management
team of three doctors, two Harvard University Medical
School graduates and the other a graduate of Johns Hopkins
University Medical School. All doctors dispensing pain medication
must be licensed by the Drug Enforcement Administration,
which regulates how much they can prescribe and for
how long.
“All of our pain management physicians are highly
trained, and we try to find the root cause of the pain rather
than throwing out opioid medicines,” says Dr. Amit Asopa,
who came to Stuart from Harvard. “Initially, the role was for
acute pain, but there is no evidence patients do well with
chronic opioid use. Patients have to be monitored for good
analgesia, signs of abuse and aberrant behavior. There has
to be improvement in function and if not, we haven’t gained
anything. Each and every patient has to be evaluated.”
RESTORE TO HEALTH
Exercise, physical therapy and rehabilitation are key elements
of the healing process, according to Asopa. Martin
Health uses a multi-faceted questionnaire to explore the patient’s
psycho-social, anxiety, depression and physical history.
The team can then determine whether there is a low or high
risk when prescribing opioids.
Back pain and headaches are the two most common ailments
for which patients seek help to endure pain. “We believe
through multimodal pain management, we can control
the way their pain is managed,” Asopa continues. “We can
use anti-inflammatory, adjunct medicines and non-opioids
to make sure the pain is managed appropriately to limit
long-term impact. People get dependent and we are trying to
avoid that, but not everyone is abusing medicines. It is for the
overall good to try and limit opioids.”
Martin Health hospitals also use ERAS protocols, offering
patients greater peace of mind. These protocols were
designed to safely reduce hospital stays and pain medication
while increasing patients’ satisfaction with their recoveries.
It begins with an individual assessment when a patient is
referred for surgery. Members of the care team look for ways
to reduce stress on the body during surgery, helping bring
about a faster recovery.
Depending on the individual, stress can be reduced
through fluid and nutrition before and after surgery, the use
of minimally invasive techniques and short-acting anesthetic
agents, removing catheters and moving the patient sooner after
surgery. The result is shorter lengths of stay and a quicker
recovery period.
Martin Health System’s pain management team consists of
Asopa, Dr. Alexander DeBonet, Dr. Zackary Boomsaad and
their support staff.