With the opioid crisis still affecting the nation, it’s important that anesthesiologists are well-educated about the problem – and about potential solutions. In tomorrow’s session “ASA Pain: Anesthesiologists’ Tailored Approach to Patient Safety Considerations When Using Opioid Analgesics,” four panelists will share strategies for maintaining patient access to appropriate pain medication and reducing the negative outcomes associated with opioid use.

Shalini Shah, M.D.

Shalini Shah, M.D., an Anesthesiologist and Pain Management Specialist at the University of California, Irvine, is among the panelists at the session, which will serve as a comprehensive program for any physician who wants to learn strategies on risk mitigation with opioids. There will also be an interactive session to create an open dialogue for how experts manage complex pain problems, given that it’s rarely a black and white equation.

“It’s crucial that anesthesiologists, and quite frankly, every specialty learn these concepts. Pain management is such a dynamic field, evolving with new medical advances each coming year. It’s great to learn about the evidence for alternatives in pain management – whether that be nerve blocks, medications or complementary medicine,” Dr. Shah said. “Each patient is also different in how they prefer to approach their pain; some prefer as aggressive as possible, some prefer to begin with complementary strategies. It’s nice to have an opportunity to get in front of the anesthesiology community and discuss these to empower the physicians.”

In providing an overview of opioid pharmacology, Dr. Shah will discuss concepts for tapering, weaning, risk stratification and the potential for addiction. In other words, it’s not necessarily about avoiding opioids but learning to use them correctly, according to fellow panelist Richard Rosenquist, M.D., Chairman of the Pain Management Department at Cleveland Clinic.

“Opioids have been a mainstay of treating acute pain,” Dr. Rosenquist said. “But we now know that even relatively short use can lead to long-term dependence. It is critical that we involve every team member in learning about appropriate opioid use and how to use other alternative strategies effectively.”

Richard Rosenquist, M.D.

The biggest hurdle for anesthesiologists, Dr. Shah said, is learning to differentiate between inadequate pain control and possible development of opioid misuse or abuse, which often can be a subtlety.

“This is where risk stratification becomes key,” Dr. Shah said. “We risk-stratify patients for cardiac health, for cancer care and, of course, for surgery. Perhaps we ought to consider routine risk stratification for opioids. Risk mitigation and stratification in health care is one of the most important tenets to successful long-term outcomes.”

Recognizing opioid misuse, abuse and addiction can be challenging and is not addressed as often as it should be in the perioperative setting, according to Dr. Rosenquist.

“If an anesthesiologist identifies someone who is clearly misusing or abusing, they should look for other non-opioid methods to improve pain control, limit any increase in opioid use and bring it up to the surgeon or managing physician,” he said.