Sometimes, when a post-operative patient is "really suffering" from acute or chronic pain, the attending physician and other caregivers are struggling, too - with questions on how to best treat that patient's pain. 
"Patients who have already been on chronic pain medications, and then undergo a painful surgery, now have a need for additional pain management," notes Todd Patterson, D.O. anesthesiologist and physician champion/ medical director of the new Adult Inpatient Acute Pain Service program at Advocate Lutheran General Hospital. "Many physicians have a certain comfort zone for prescribing drugs for pain, which they hesitate to leave." 
That's when the acute pain service team steps in on Lutheran General Hospital's rehabilitation unit. Michele Yurgil, APN, and Noreen Kelly, Pharm. D., clinical staff pharmacist, join Dr. Patterson on the hospital's team.
"There are so many pain management options out there," Kelly says. "These patients' physicians and caregivers want to know what their options are - they're not comfortable managing these levels of pain because they've not had that experience in the past."
John Sage, M.D., president of Lutheran General's medical staff, said many doctors have little or no training in the area of pain management, therefore the acute pain service team was formed to address the trepidation of those physicians and nurses who have less training in the area of acute pain management, and to help them feel more comfortable with evidence-based protocols. 
Once that comfort zone has been expanded, the next objective of the team is to educate physicians and nurses about existing pain management protocols and to make recommendations upon request.  For example, if standing orders aren't relieving the pain of a given patient, then the caregivers of that patient can consult with the acute pain service team concerning alternative prescribed care that still qualifies as protocol.    
"Sometimes they're just not aware of new drugs that have come out that could be used," Dr. Patterson says.  "Or they have a fear of dealing with an addicted patient.  In reality, the drugs that are administered are used short-term and as the pain diminishes, the treatment is tapered down. We constantly reassess the patients' comfort level and our goal is to get down to the lowest possible dose prior to discharge."
Kelly adds that individualized care for patients in pain, as opposed to a 'cookie-cutter' approach, helps them reach this goal more effectively.
The first person to meet with any physician or caregiver requiring acute pain management consultation is Michele Yurgil, the team's advanced practice nurse.
"Initially, Noreen and I review the patient's history and then perform a total pain assessment.  We then contact Dr. Patterson to develop a pain management plan. Of course, the patient has to be agreeable to the plan as well. We get a plan in place much sooner by doing it this way. It's a very efficient process," Yurgil said.
Yurgil and Kelly also provide what they call 'curb-side consults,' which usually result from a nursing-generated concern that may not require a formal consult.  For example, if a post-operative patient indicates his pain level is 10 (the highest), the nurses may be looking for guidance to follow an order-set they already have at their disposal.
 "Originally, our team set out to be a consultation service only," Dr. Patterson points out.  "But we found at times there can be too much down time for the patient, so we decided to do what was necessary - within the realm of patient safety - to get them on a plan, with the intent of tapering off to the point of being discharged."
  Kelly notes, "Sometime this ramps up to the primary physician," Kelly notes, adding they will call the attendings to notify them if the current medication order is not effective.
It's a team approach, according to Dr. Patterson. "We put our heads together to look at all interventional means to achieve the ultimate goal of relieving patients' acute pain while assuaging physicians' and caregivers' concerns for safety and effectiveness," he said.
Kris Narasimhan, M.D., vice president, medical management, said this approach by the team is a physician as well as patient satisfier.  "Most doctors want to hear the pain management of their patients is being handled," he said.  "They prefer not getting the call that a patient of theirs is in acute pain."
Thus far, in measuring pain scores of patients before, during and after the team's consultations, pain scores are trending downward.
The team is now looking to expand its services to other areas of the hospital, addressing migraine patients as well.

# # #

Photo Caption: The Adult Acute Pain Services team at Advocate Lutheran General Hospital works in tandem to educate physicians and nurses about existing pain management protocols, and to make recommendations upon request.  From left: Noreen Kelly, Pharm. D.; Todd Patterson, D.O. anesthesiologist; and Michelle Yurgil, A.P.N.