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Sanford Health to Study Alternatives to Opioids

Nov 27, 2017 02:24PM ● Published by Digital Media Director

Sanford Health is one of three sites in the U.S. to launch a study to determine if non-opioid medications are as effective in managing pain after carpal-tunnel surgery.

Carpal tunnel syndrome is a condition causing numbness, tingling or pain in the hand and arm.  The surgery to treat the condition is one of the most common surgical procedures in the U.S. This double-blind study will evaluate the effectiveness of two pain management courses: hydrocodone and acetaminophen or ibuprofen and acetaminophen.

Opioid addiction continues to be a crisis in the United States, with nearly 100 Americans dying every day from overdoses, according to the Centers for Disease Control and Prevention. More than half of all drug overdoses are related to opioids, and prescriptions for them have nearly quadrupled since 1999.

This study seeks to better understand pain management and find alternatives to prescribing opioids.

“Opioid addiction is a real concern for surgeons,” said Robert Van Demark Jr., M.D., who is the principal investigator for the study and hand surgeon with Sanford Orthopedics and Sports Medicine. “We know that there’s a need to both balance the pain management of our patients and to ensure we do everything we can to combat possible addictions. This study is one step we can take to better understand how to do that.”

The study, which began in October, is based on work from a researcher in Canada. Health systems in Roanoke, Virginia, and Philadelphia, Pennsylvania, also are taking enrollees.

To be eligible for the study, enrollees must be 18 years or older, not be on a pain management or ibuprofen or acetaminophen regimen, have no prior addiction or substance abuse and not have cardiovascular or liver diseases. Participants will be followed for two weeks post-operation and be asked to keep a pain journal.

Sanford’s own in-house efforts already appear to be having an impact on the problem. By tracking opioid prescriptions through the EMR system and providing education around best practices, the health system has cut the number of pills and prescriptions by nearly 25% in the last two years.

Dan Heinemann, MD, is one of the people working on the opioid issue at Sanford as the VP and Medical Officer for Sanford Health Network and Clinic and described to MED some of the changes he’s seen.

“Our surgical clinicians were prescribing 30 to 60 days of meds postoperatively,” says Heinemann. “But some patients may only need five or ten, especially if the surgery corrected the issue that was causing the pain. With that data and knowing that best practice is to prescribe less, many surgeons are now prescribing five to seven days and partnering with physicians to take care of additional needs.”

Heinemann says this practice, which has now been implemented system-wide, helps keep uneeded medications out of patients’ medicine cabinets. In addition, a controlled substance stewardship group developed short education modules around opioid use, which every clinician is required to complete.

As clinicians change their practices, Heinemann says Sanford will be ready to back them up by providing resources like drug use “contracts” for patients and enhancing areas like physical therapy, psychiatric services, and behavioral health services to help patients with issues that go beyond physical pain.

“You can’t ask someone to change the way they practice without providing them with the tools,” he says. “The bottom line is that we don’t want anyone to suffer...whether that suffering comes from chronic pain or from dependence on opioids, which may result in addictive behaviors or even overdose.”

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