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Multimodal Analgesia

Every day you work to relieve your patients’ pain while managing risks, especially following surgery. Balancing the risks and benefits of opioids can be challenging.

Help patients manage pain with a multimodal plan

Almost 80% of patients want non-opioid options to treat pain, but fewer than 1 out of 4 discuss this with their healthcare professional.2* Support your patients with a multimodal pain management plan to reduce the unintended consequences of opioids. A multimodal pain management plan can include multiple medications and techniques, including opioid, non-opioid (prescription or OTCs), and topical medications, as well as nonpharmacologic therapies.1

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Keep multimodal analgesia reminders on hand when creating pain management plans with your patients.

Evidence for OTC analgesic efficacy is strong

Nearly 90% of patients are concerned about side effects associated with opioids, especially addiction. There are ways to address those concerns and still provide effective pain relief.1,2*

Numerous studies support the efficacy of OTC analgesics for a variety of acute and chronic pain states.3-8

The American Pain Society strongly recommends that acetaminophen and/or NSAIDs be used as part of a multimodal analgesic treatment plan.1

Consider and discuss the efficacy of OTCs with patients

When you recommend an OTC analgesic as part of a patient's pain management plan, remind them to:

  • Follow your recommendation exactly. Patients may stop their analgesic regimen if they feel their pain is under control. Encourage them to follow your dosing directions to stay ahead of their pain.

  • Define personal goals. Explain that eliminating pain completely may not be achievable and work together to create realistic, meaningful goals that can help patients get back to normal functioning.

  • Keep you informed on their progress. Revisit your patients’ pain and function levels and adjust their pain management regimen accordingly.

  • Use OTC pain medicine safely. Provide handouts with OTC analgesic dosage and frequency. Don’t forget to ask about other medications your patients may be taking.

Involve your patients to make their pain plan

An individualized, patient- and family-centered plan that’s unique to each patient is recommended.1

Remember to:

  • Ask your patients about their pain management preferences. Nearly 4 out of 5 patients would choose a non-opioid pain relief option for postoperative pain, but fewer than 1 in 4 discuss this with their healthcare professional.2*

  • Communicate clearly and concisely. Patients may feel overwhelmed or forget to ask important questions.

  • Give them this simple, easy-to-use planner.

  • Reinforce OTC analgesic efficacy. When used as part of multimodal analgesia, OTC analgesics can provide more effective pain relief than opioids alone.1

  • Personalize their plan. Each patient has different recovery goals and interest in nonpharmacologic therapies. Consider personal health conditions and gauge interest in alternative pain treatment options.

Alternative pain management therapies, including physical modalities, may also be used. Patients may benefit from techniques such as1,9,10:

  • Transcutaneous electrical nerve stimulation (TENS)

  • Cold and heat therapy

  • Acupuncture

  • Massage

Keep multimodal analgesia reminders on hand when creating pain management plans.

Find amount, dose, frequency, and daily limits for acetaminophen and NSAIDs.

*Based on a 2016, 500-person survey of patients who had orthopedic surgery.
REFERENCES: 1. Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131-157. 2. Data on file. Based on a 2016, 500-person survey in patients who had orthopedic surgery. Pacira Pharmaceuticals. Plan against pain. Opioid addiction and dependence after surgery is significantly higher than previously known. 2016. 3. Milsom I, Minic M, Dawood MY, et al. Comparison of the efficacy and safety of nonprescription doses of naproxen and naproxen sodium with ibuprofen, acetaminophen, and placebo in the treatment of primary dysmenorrhea: a pooled analysis of five studies. Clin Ther. 2002;24(9):1384-1400. 4. Moore RA, Derry C. Efficacy of OTC analgesics. Int J Clin Pract Suppl. 2013;178:21-25. 5. Patel S, McGorray SP, Yezierski R, Fillingim R, Logan H, Wheeler TT. Effects of analgesics on orthodontic pain. Am J Orthod Dentofacial Orthop. 2011;139:e53-e58. 6. Schug SA, Sidebotham DA, McGuinnety M, Thomas J, Fox L. Acetaminophen as an adjunct to morphine by patient-controlled analgesia in the management of acute postoperative pain. Anesth Analg. 1998;87:368-372. 7. Stockler M, Vardy J, Pillai A, Warr D. Acetaminophen (paracetamol) improves pain and well-being in people with advanced cancer already receiving a strong opioid regimen: a randomized, double-blind, placebo-controlled cross-over trial. J Clin Oncol. 2004;22:3389-3394. 8. Varner J, Lomax M, Blum D, Quessy S. A randomized, controlled, dose-ranging study investigating single doses of GW406381, naproxen sodium, or placebo in patients with acute pain after third molar tooth extraction. Clin J Pain. 2009;25:577-583. 9. Wu MS, Chen KH, Chen IF, et al. The efficacy of acupuncture in post-operative pain management: a systematic review and meta-analysis. PLoS ONE. 2016;11(3):e0150367. 10. Kukimoto Y, Ooe N, Ideguchi N. The effects of massage therapy on pain and anxiety after surgery: a systematic review and meta-analysis. Pain Manag Nurs. 2017;18(6):378-390.