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[Dalek]

An ER Kicks the Habit of Opioids for Pain

Lauren Khalifeh, a nurse and St. Joseph’s holistic coordinator, doing a treatment called pranic healing in the emergency room. The hospital has introduced protocols in the ER that seek to avoid opioids for common types of acute pain.

Since Jan. 4, St. Joseph’s Regional Medical Center’s emergency department, one of the country’s busiest, has been using opioids only as a last resort. For patients with common types of acute pain — migraines, kidney stones, sciatica, fractures — doctors first try alternative regimens that include nonnarcotic infusions and injections, ultrasound guided nerve blocks, laughing gas, even “energy healing” and a wandering harpist.

Scattered ERs around the country have been working to reduce opioids as a first-line treatment, but St. Joe’s, as it is known locally, has taken the efforts to a new level.

“St. Joe’s is on the leading edge,” said Dr. Lewis S. Nelson, a professor of emergency medicine at New York University School of Medicine, who sat on a panel that recommended recent opioid guidelines for the Centers for Disease Control and Prevention. “But that involved a commitment to changing their entire culture.”

In doing so, St. Joe’s is taking on a challenge that is even more daunting than teaching new protocols to 79 doctors and 150 nurses. It must shake loose a longstanding conviction that opioids are the fastest, most surefire response to pain, an attitude held tightly not only by emergency department personnel, but by patients, too.

Pain is the chief reason nearly 75 percent of patients seek emergency treatment. The ER waiting rooms and corridors of St. Joe’s, where some 170,000 patients will be seen this year, are frequently pierced by high-pitched cries and anguished moans.

Jan Lucas, 75, playing a “therapy harp” in the ER. It is one of many alternative approaches that St. Joseph’s uses to ease pain.

Such pain can be quickly subdued with opioids — Percocet and Vicodin pills; intravenous morphine and Dilaudid. Most doctors say those drugs can’t be altogether replaced. In extreme emergencies — a broken bone jutting through skin; a bad burn; an acute sickle cell crisis — opioids provide effective, immediate relief.

But it is what happens after patients leave the ER that public health experts believe has contributed to a crisis of addiction in the United States. At discharge, patients are often given opioid prescriptions. Since the medication has kept their pain at bay, they seek refills from their primary doctors. Though many never become dependent, others do. And so although emergency physicians write not quite 5 percent of opioid prescriptions, ERs have been identified as a starting point on a patient’s path to opioid and even heroin addiction.

“Because we are often the first doctors to provide the patient with opioids for acute pain, we have set in their minds that it’s the right treatment,” said Dr. Nelson.

Mindful of the exponential rise in opioid addiction at his hospital’s doorstep, Dr. Mark Rosenberg, St. Joe’s chairman of emergency medicine, began asking two years ago whether it was possible to treat many patients who arrive in the ER without opioids. He sent Dr. LaPietra on a fellowship year to study pain management at specialty departments at St. Joe’s and other hospitals. She trained the St. Joe’s staff. The ER’s pharmacy stocked the alternative medications. Dr. Rosenberg alerted departments throughout the hospital to sustain the opioid-avoidant philosophy when seeing ER patients for follow-up visits.

So far the approach has proved effective. In five months, the hospital has reduced opioid use in the emergency department by 38 percent. St. Joe’s has treated about 500 acute pain patients with non-opioid protocols. About three-quarters of the efforts were successful. Mrs. Pitts, the patient whose neck and arm pain was alleviated by a trigger-point injection, went home with non-opioid patches. She told ER staff in a follow-up call that she didn’t need further medication.

St. Joe’s is even cautiously trying therapies not typically taught in medical school. A nurse practitioner is studying acupuncture for pain. And another nurse, Lauren Khalifeh, the hospital’s holistic coordinator, does a treatment called “pranic healing.”

One afternoon, Mrs. Khalifeh visited a brittle-thin older patient whose sciatica was so inflamed she could not rise from her chair. On a scale of one to 10, the woman, doubled over, said her pain was a 10.

Mrs. Khalifeh pulled up a chair. “I am going to sweep the energy,” she told the patient. She opened a bottle of saline water. “The salt will destroy the negative energy.”

Dr. LaPietra, hard-wired with scientific skepticism, observed from a corner.

The patient closed her eyes, placing hands on lap, palms up. Mrs. Khalifeh leaned intently toward her, sculpting the air in figure eights. She stirred and swirled the space, and then passed her hands over each other. Then she hovered a palm near the patient’s heart.

“Let’s do a check-in,”said Mrs. Khalifeh.

The patient slowly stood. She walked over to Dr. LaPietra, who watched, open-mouthed.

“Much better,” the patient said. “Now it’s a five.”

Mrs. Khalifeh continued for two more minutes. “It’s a three,” said the patient wonderingly, doing deep knee-bends in her leather pants.

The entire process took about six minutes.

Dr. LaPietra’s eyes glistened with tears.

 

[perfectchaos007]

holistic alternative medicine in real hospitals? wtf?

 

[entremet]

Good that hospitals are addressing this problem somewhat.

Pranic healing sounds like BS though.

 

[Skellig Gra]

It's a good idea to reduce opioid usage but this holistic stuff just seems like total BS to me.

 

[ElectricBlanketFire]

Yeah if I came into the ER with intense pain and they told me to play a harp, I'd be pissed.

 

[cr0w]

Yeah if I came into the ER with intense pain and they told me to play a harp, I'd be pissed.

This.

There might also be things thrown at the lady attempting pranic healing.

 

[Jenov]

lol using "energy healing" for fucking kidney stones and fractures... wtf.

 

[Krauser Kat]

awesome. My mom bitches about this all the time.

Hospitals kind of got fucked by the ACA.

They are now at the whim of addicts that will continually come in on medicaid and demand opioids for pain. if they dont give it to them they cause a ruckus and can complain. This hurt the hospitals customer satisfaction number which further reduces what it gets from medicare/medicaid.

 

[DOWN]

holistic alternative medicine in real hospitals? wtf?

Not for extreme cases, but just as part of a combo of less addictive drugs. It can calm the patients and distract them apparently, helping avoid the idea that they need to be knocked into painless mode by harder meds when their pain isn't clearly dictating it. I'd prefer to see some studies as I'm rather not into holistic medicine outside of people enjoying a mild placebo in their daily life.

 

[Luschient]

"Hey there, I know that kidney stone is making you experience the worst pain imaginable, please enjoy this harp music in lieu of actual relief".

 

[Jarmel]

lololololololol

I can't laugh hard enough at this.

 

[see5harp]

Seriously I'd rather be addicted to opoids than smell like sandalwood all of the time and have to sit through that lady's chakras for an afternoon.

 

[Amory]

If I was at the hospital in severe pain and they brought in a harp instead of the good shit i'd be pissed

 

[echoshifting]

I can see why this makes sense for regular ER visitors with a constant cycle of tests indicating they are healthy, but for everyone else it really sucks.

 

[thelatestmodel]

This is not medicine.

 

[Dalek]

lololololololol

I can't laugh hard enough at this.

I really liked the photos.

 

[Shao Kahn Brewing a Stew]

I want someone to play therapy harp when I eventually go get a q-tip shoved up my penis. I heard that shit is painful.

 

[BlueTsunami]

Yeah if I came into the ER with intense pain and they told me to play a harp, I'd be pissed.

And the emergency harp session will cost $2K w/o insurance, $200 copay with

 

[DOWN]

Guys they still use medicine, but they are just trying to do whatever they can to chill out the ER so people stop yelling for opioids.

They absolutely use the opioids for the big stuff, they are just trying to prevent the over prescriptions.

Most doctors say those drugs can’t be altogether replaced. In extreme emergencies — a broken bone jutting through skin; a bad burn; an acute sickle cell crisis — opioids provide effective, immediate relief.

 

[SRG01]

Yeah if I came into the ER with intense pain and they told me to play a harp, I'd be pissed.

It's no different than drawing the attention of the patient into other activities to dull the sensation of pain. For instance, video games and other activities have been used in Children's wards for pain management.

 

[Dalek]

I want someone to play therapy harp when I eventually go get a q-tip shoved up my penis. I heard that shit is painful.

 

[Dr_Boris_Goltz]

That top picture is absurd.

 

[Wag]

I wonder how insurance rationalizes paying for this?

 

[I Stalk Alone]

holistic alternative medicine in real hospitals? wtf?

The placebo effect is....

UNLIMITED POWER!!!

 

[Catdaddy]

Sorry your leg is broken, now I will play you some Yanni...

 

[yanipheonu]

Reason #275 Medical Marijuana should be legal. It's a great potential pain killer for many patients, but much less addictive than opioids, with less side effects.

Don't estimate the power of auditory or aroma based pain treatments. It's no opium, but for stuff like headaches it's surprisingly helpful. I find a stick of incense in the room does more for my frequent headaches than Tylenol, not to mention a good smell just being good against anxiety. Knew a guy who straight up did song therapy, had some interesting stories. And binaural sounds are surprisingly effective at certain things.

Distraction itself can be the best painkiller. Video games can actually be great for ignoring pain. Found myself playing lots of games while getting over surgery.

 

[BlueTsunami]

Sorry your leg is broken, now I will play you some Yanni...

Due to licensing issues, Enya isn't covered by your insurance. We apologize.

 

[blame space]

they're gonna get people damn addicted to that therapy harp! playing with fire IMO

 

[echoshifting]

It really bothers me that virtually all doctors' offices and hospitals still list marijuana as an "illicit" or "recreational" substance, even when you have a medical id card. It really is a good alternative to opioids for some people (myself included).

But yeah let's just ignore that and prescribe mad harp jams

 

[ElectricBlanketFire]

It's no different than drawing the attention of the patient into other activities to dull the sensation of pain. For instance, video games and other activities have been used in Children's wards for pain management.

I can assure you playing video games is not enough of a distraction to manage pain.

 

[jb1234]

I can assure you playing video games is not enough of a distraction to manage pain.

Yup. I wish it were though.

 

[echoshifting]

I can assure you playing video games is not enough of a distraction to manage pain.

Indeed, I find the inverse to be true; when I'm in serious pain I'm too distracted to play video games.

 

[Alavard]

I can assure you playing video games is not enough of a distraction to manage pain.

Depends on the level of pain and the person.

 

[HStallion]

Just have them starting playing a Korean MMO and by the time they leave they'll be addicted to the game so badly they won't even feel the pain anymore.

 

[Toxi]

The placebo effect is....

UNLIMITED POWER!!!

The Dark Side of the Force is a pathway to many abilities some consider to be unnatural.

 

[PeskyToaster]

Just give me something to bite down on

 

[Giolon]

Edit: nvm, kind of a derail

 

[entremet]

It really bothers me that virtually all doctors' offices and hospitals still list marijuana as an "illicit" or "recreational" substance, even when you have a medical id card. It really is a good alternative to opioids for some people (myself included).

But yeah let's just ignore that and prescribe mad harp jams

They're only following the laws--federal ones. Hospitals are highly regulated so its a way for them to cover their asses legally.

Malpractice insurance is expensive enough. Through an illegal substance in there and here you are.

 

[echoshifting]

They're only following the laws--federal ones. Hospitals are highly regulated so its a way for them to cover their asses legally.

Fair enough. It's just unfortunate.

 

[inner-G]

Anything to keep cannabis demonized...

 

[SRG01]

I can assure you playing video games is not enough of a distraction to manage pain.

Well, it's not the only thing that they give the patient. They can give other painkillers and other therapies simultaneously in order to avoid the use of opiods.

Anecdotally, this is exactly what happened to me years ago because I had a severe reaction to Tylenol 3, which contains codeine. I was prescribed a strong NSAID, but had to manage my own pain in a variety of ways -- like playing video games.

The most important takeaway is that opiod use is terrible for long term pain management, and short term pain management can be done without opoids.

Reason #275 Medical Marijuana should be legal. It's a great potential pain killer for many patients, but much less addictive than opioids, with less side effects.

Don't estimate the power of auditory or aroma based pain treatments. It's no opium, but for stuff like headaches it's surprisingly helpful. I find a stick of incense in the room does more for my frequent headaches than Tylenol, not to mention a good smell just being good against anxiety. Knew a guy who straight up did song therapy, had some interesting stories. And binaural sounds are surprisingly effective at certain things.

Distraction itself can be the best painkiller. Video games can actually be great for ignoring pain. Found myself playing lots of games while getting over surgery.

Synthetic Canniboids (spelling?) are going to be the next gold mine in pharmaceuticals. Have any gone through successful clinical trials yet?

 

[Hazmat]

If I have a kidney stone and they want to try this shit instead of giving me vicodin I'm going to google how far away the closest other emergency room is.

 

[Wag]

Reason #275 Medical Marijuana should be legal. It's a great potential pain killer for many patients, but much less addictive than opioids, with less side effects.

Don't estimate the power of auditory or aroma based pain treatments. It's no opium, but for stuff like headaches it's surprisingly helpful. I find a stick of incense in the room does more for my frequent headaches than Tylenol, not to mention a good smell just being good against anxiety. Knew a guy who straight up did song therapy, had some interesting stories. And binaural sounds are surprisingly effective at certain things.

Distraction itself can be the best painkiller. Video games can actually be great for ignoring pain. Found myself playing lots of games while getting over surgery.

I went in to the ER last year with one of the worst persistent headaches I ever had- it lasted 3weeks. I was in agony. The doctor sent me for a CAT scan, it came back negative and told me to take some aspirin and sent me home. I refused to leave without treatment. She offered me opioids, I refused that too. She finally gave me an injection of Toradol which is a really strong, non-addictive pain reliever, essentially a really concentrated shot of Aspirin. It worked.

If I was in severe pain and was offered a holistic treatment I wouldn't stand for it.

 

[Burt]

Just give me something to bite down on

Pretty much how it needs to be. People don't like to hear that sometimes they just have to hurt.

 

[scorcher59]

Try to blame the opioid all you want but the over prescription never gets adressed because of the old "trust me I'm a doctor" mantra. The people with the legal and therapeutical obligation to prescribe will never be called on their trigger happy opioid prescription

 

[yanipheonu]

I can assure you playing video games is not enough of a distraction to manage pain.

I mean it won't say it'll replace a good painkiller for truly terrible pain, but don't underestimate the psychological aspect of pain. Pain isn't just something you put a chemical bandaid on, a major part of it is handling how patients deal with the pain psychologically. Distraction, fixating on something else other than the pain, and lower ones feeling of pain's intensity are important.

 

[Steeped in a Sea of Games]

Harp music isn't gonna help me when I'm kicking down the walls and crumpling over due to extreme kidney stone pain.

 

[Rockandrollclown]

So conflicted on this. The holistic medicine is bullshit, but honestly placebo is probably better than continuing to get people hooked on opioids.

 

[Hoo-doo]

I can assure you playing video games is not enough of a distraction to manage pain.

That's interesting you say that, i'm currently involved in a medical research project trying to manage post-surgical pain with the use of Virtual Reality. The pilot studies have shown very positive results. The power of distraction can be more potent than you think.

 

[Dot-N-Run]

Really? Pranic healing? Is there any scientific evidence that backs this stuff up at all? I followed the link in the article to the pranic healing website and it just screamed scam to me.

The hospital has noble goals, trying to ease off on overprescribing addictive drugs that are having an impact on society. But this is not the way to go about it at all.