Collections > Master's Papers > Gillings School of Public Health > Multimodal Analgesia: A Solution to the Epidemic of Opioid Monotherapy for the Treatment of Acute Pain in the Inpatient Hospital Setting

Over the last several decades the topic of acute pain management has led to several pendulum swings in clinical practice and has now elevated to the level of patient safety. This problem came to light in the 90s with the persistent underuse of acute pain medications that led to an increased awareness of the need to adequately assess and treat patients' pain.1,2,3 In recognition of this ongoing inadequate treatment of acute pain, APS (see glossary) designated pain as "the fifth vital sign" in 1995.4 As a community made up of HCPs (see glossary), scientists and other pain experts, their goal is to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering.5 While successful in bringing pain assessment and treatment to the forefront for healthcare providers, the "Pain as the Fifth Vital Sign" campaign has unfortunately led to the unintended consequence of an over-reliance on opioid medications. In an attempt to provide adequate analgesia for their patients, HCPs often prescribe opioid monotherapy (opioids only) to treat acute pain. Opioids, while effective, are associated with serious and sometimes fatal adverse events. The pendulum has swung in the opposite direction, moving from a lack of awareness of the need to assess and optimally treat acute pain, to now over-treating with opioid monotherapy, which can cause harm and put patients' safety at risk. With new and emerging non-opioid options for treating acute pain management, HCPs should assess patient risk for adverse effects and employ a MMA approach. This approach uses the lowest effective opioid dose needed and thus minimizes the adverse effects to the patient. The APS is set to release new guidelines in January, 2016 on use of MMA for acute pain management in the hospital setting. There is an urgent need for the implementation of risk assessment tools and opioid minimization strategies in hospitals across the country to provide safe and effective treatment of acute pain. Both HCPs and patients alike would benefit from education on MMA and the non-opioid options available for treating acute pain. Education and implementation of a MMA approach has proven to be efficacious and safe while enhancing recovery for patients and reducing costs associated with length of stay to the hospital. Not only does a MMA approach lead to safe and effective acute pain management for the hospitalized patient, but it may potentially reduce the incidence of chronic pain that results from inadequate treatment of acute pain. A 2008 review article by Macrae describes how postoperative pain has been shown to correlate with the incidence of chronic postsurgical pain.6 This paper will review one promising strategy to appropriately preventing chronic pain and avoid analgesic gaps, the MMA approach.