Current Trends & Challenges in Pain Management: Q&A With Dr. Theresa Bowling of Stamford Hospital Anesthesiology Department

Dr. BowlingTheresa Bowling, MD, is the vice chairman of the department of anesthesiology at Stamford (Conn.) Hospital. Dr. Bowling earned her medical degree from the State University of New York and completed her residency at Yale New Haven (Conn.) Hospital. Here she discusses alternatives in post-surgical pain management, how pain management alternatives can lead to decreased length of stays and the biggest challenge anesthesiologists will face in the next year.

Q: What are a few of the most important issues that physicians and anesthesiologists should be focusing on in terms of post-surgical acute pain management?

Dr. Theresa Bowling: One of the areas that surgeons and anesthesiologists alike should focus on is exploring alternatives to narcotics for managing post-operative pain. Narcotics have a whole list of side effects that are unpleasant for patients. In particular, patients may experience nausea, vomiting and sedation. Often when I've queried patients, they are more concerned about the side effects from narcotics than they are about the pain. If you can decrease the amount of narcotics by using pain relief pumps that deliver a regulated flow of local anesthetic you may remarkably reduce the use of narcotics and improve the overall perioperative experience for the patient.

Q: What options should physicians present to their patients in terms of surgical pain management?

TB: Physicians need to let patients know that there's more than one option to treat pain for most surgical procedures. At Stamford Hospital we do the majority of our cases with nerve blocks and local anesthesia meaning that the entire body does not need to be numbed, rather you just numb the effective part of the body that is having surgery, whether it be an arm, a leg, an abdomen or a chest wall. For example, physicians need to be aware of the ON-Q Pump with ONDEMAND. The ONDEMAND pump delivers local anesthetic through an indwelling peri-neural catheter giving patients the option to recover at home as they are allowed to control the dosing for pain relief, enabling them with an active role in their pain management.

If you can help avoid the unwanted side effects related to general anesthesia and narcotics, this may translate to a faster recovery and very often a decreased length in stay with the in-patient population.

Q: Do you think pain pumps, as opposed to pain killers, will be a growing trend?

TB: Yes. I think that the focus on anesthesia within the next decade will be on regional anesthesia as opposed to general anesthesia. This is especially true for our aging population as those patients have a really hard time recovering from general anesthesia. They often run the risk of developing post-operative dementia which translates to additional costs for the patient and the hospital.

Q: What is the biggest challenge anesthesiologists will face over the next year for the treatment of pain?

TB: I believe that the biggest challenge will be in terms of training anesthesiologists in newer techniques of regional anesthesia. Ten to fifteen years ago, anesthesiologists likely did not have exposure to these techniques, which have now become the standard of care at most hospitals. In addition to regional anesthesia, ultrasound imaging has also become the standard of care for placing nerve blocks.

There's really no area within the body now that can't be blocked with regional anesthesia, whether it's a sole anesthesia procedure or an adjunct to sedation and/or general anesthesia. Training physicians and anesthesia colleagues in up-to-date techniques is critical to patient care and outcomes.  

More Articles on Pain Management:
Dr. Katherine Mason Joins Harrington HealthCare System
Dr. Leo Lombardo Opens Ventura Pain & Spine Physicians
Spine Specialist Dr. Roberta Kalafut Honored for Volunteer Work

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