Pain is one of the chief complaints that results in patient admissions to the hospital. Hospitalists inevitably confront pain issues every day, says Joe A. Contreras, MD, FAAHPM, chair of the Pain and Palliative Medicine Institute at Hackensack University Medical Center in Hackensack, N.J. As a result, “it is expected that all physicians who take care of sick people have some baseline knowledge of opioids use,” Dr. Contreras says.
There is a preference on the public’s part and, consequently, from the physician’s perspective to treat pain with opioids, even though minor cases can be controlled without pharmacologic interventions, Dr. Contreras says. Patients might receive some relief from repositioning, hot or cold packs, extra pillows, Reiki therapy, and other soothing modalities. Additionally, hospitals can benefit from having a pain champion on staff to safely manage various situations.
Tapping the insight of in-house pain services is even more important in complex cases, says hospitalist Solomon Liao, MD, FAAHPM, director of palliative-care services at the University of California at Irvine. He recommends turning to a board-certified pain specialist or a palliative-care expert. Some hospitals also employ or offer access to addiction specialists. At a minimum, a pharmacist or pain consultant should be available.
A hospitalist should still obtain important and relevant information when a patient is admitted. This includes the pain medicine the patient is taking and how often, who prescribed it, whether it helps, and if the patient has experienced side effects.
“As the primary-care physician in the hospital,” Dr. Liao says, “the hospitalist is ultimately responsible.”
Special attention is needed during care transitions.
“This is when patients are most vulnerable,” says Beth B. Murinson, MS, MD, PhD, associate professor and director of pain education in the department of neurology at Johns Hopkins University School of Medicine in Baltimore.
These situations occur during transfers from the ED or recovery room to an inpatient unit, and from hospital to home or skilled nursing facility. Patients being discharged must be thoroughly informed about their opioid pain relievers, Dr. Murinson says, with instructions to store them in a secure place. TH
Susan Kreimer is a freelance writer in New York City.