Asokumar Buvanendran, M.D., is William Gottschalk Endowed Chair of Anesthesiology and Executive Vice Chair, Rush University Medical Center, Chicago.

Asokumar Buvanendran, M.D., is William Gottschalk Endowed Chair of Anesthesiology and Executive Vice Chair, Rush University Medical Center, Chicago.

David Ring, M.D., Ph.D., is Associate Dean for Comprehensive Care, Professor of Surgery and Psychiatry, Dell Medical School, The University of Texas at Austin.

David Ring, M.D., Ph.D., is Associate Dean for Comprehensive Care, Professor of Surgery and Psychiatry, Dell Medical School, The University of Texas at Austin.

ASA is proud to announce the launch of our Pain Alleviation Toolkit. Partnering with the American Academy of Orthopaedic Surgeons (AAOS), this collaboration started over two years ago when federal policymakers were exploring solutions to address the overprescribing of opioids and challenges associated with substance use disorders. A key element of our partnership was to develop a more comprehensive approach to alleviating pain in the perioperative setting, rather than just focusing on medications and opioids. We spent numerous hours identifying best practices and coming to a consensus on strategies for safe and effective pain alleviation.

Foundational to this mission were the ideas that: 1) postoperative pain alleviation is a communitive process involving healthcare providers of various types, patients and their families, and 2) that perioperative pain alleviation practices have far-reaching effects, both for individuals and for society. Effective strategies utilize open communication, inspire active participation and promote optimal opioid stewardship by attending to the patient-clinician relationship, and mental and social health opportunities, in addition to physical techniques and a variety of medications. This toolkit offers effective strategies to reach those goals and serves as an example for future multispecialty collaboration projects.

Together, orthopaedic surgeons and anesthesiologists can identify and address all opportunities for people to get comfortable safely. For instance, symptoms of depression or anxiety, unhealthy thoughts (e.g. worst-case thinking or fear of painful movement), smoking, daily opioid intake, the potential for technical variations such as local or regional anesthesia and the anticipated level of nociception (tissue damage) can facilitate implementation of comprehensive strategies for alleviation of pain with optimal opioid stewardship. Ensuring that patients and families are ready for the recovery process and know how to contact the team if they are concerned is equally important. This toolkit provides tips, techniques, videos and guides to facilitate conversations between the surgical team as well as patients and families to help assure patients are as comfortable as possible, as safely as possible.

Studies have found that a majority of the opioids prescribed by surgeons to treat acute postoperative pain are not used. If not disposed of appropriately, these unused opioid pills place patients and their families at risk for diversion, misuse and addiction.

While opioids help alleviate pain, they are also habit forming and suppress respiration. Perhaps most importantly, opioids treat both emotional and physical pain. People taking opioids might find relief of despair that draws them in to unhealthy use. It is not possible to overstate the impact opioids have had on our society, and the current opioid crisis in the United States and Canada can, in large part, be traced to promotion of opioids as the primary and most effective treatment for pain.

There is wide variation among orthopedic surgeons regarding the types of opioids used, number of pills prescribed, and how often and for how long they provide refills. Studies have found that a majority of the opioids prescribed by surgeons to treat acute postoperative pain are not used. If not disposed of appropriately, these unused opioid pills place patients and their families at risk for diversion, misuse and addiction. The toolkit includes clear instruction regarding safe use, storage and disposal practices so that we can help assure that these helpful but dangerous medications are handled appropriately.

The ASA and the AAOS recognize the need for focused strategies for safe and effective alleviation of pain. Using straightforward, interactive and informative modules, the toolkit provides surgeons, anesthesiologists and other health care staff easy access to planning resources to enhance communication with patients and ensure effective, safe and socially responsible pain alleviation. By partnering together and implementing coordinated pain care strategies, we believe we can not only improve perioperative comfort but can also improve opioid prescription practices and help limit opioid misuse. We encourage you to check out the toolkit at (asahq.org/pain-toolkit) which just launched in March. Building upon the success of this unique multispecialty partnership, we hope to further improve physician collaboration, moving forward to help solve health care’s toughest issues.