An Update from the CSA Committee on Pain Medicine
By Rakhi Dayal, MD
The California Society of Anesthesiologists (CSA) is celebrating Pain Awareness Month to educate and empower the chronic pain patients of California. Here, we share a patient story, highlighting the importance of involving a pain physician in the treatment of chronic pain.
Patient story:
A 52-year-old woman sustained a complex fracture of the right leg after a motor vehicle accident. To repair the injury, she eventually underwent multiple surgeries over the next three years. Despite these surgical interventions, the bone would not heal properly, resulting in severe constant pain in the right knee and lower leg. The patient required the usage of opioids as well as non-opioid medications such as acetaminophen, gabapentin, and methocarbamol for pain management. Her quality of life was impacted severely, and she was unable to pursue her routine activities. Eventually, she began to develop side effects from her medication regimen, limiting her functionality and leading her to quit a job that she loved. Even then, her pain continued to persist.
She was then referred to a pain physician who suggested a trial of a peripheral nerve block, specifically an adductor canal block done under ultrasound guidance. The local anesthetic administered for the adductor canal block reduced pain in the knee and the inside of the leg below the knee. For the first time since her injury, the patient experienced tremendous relief after the nerve block. Given the success of this trial, her pain physician recommended implantation of a peripheral nerve stimulator, which could provide sustained pain relief. The patient agreed. After implantation of the stimulator, her pain decreased significantly, leading her to stop taking all medications causing adverse effects. She is now back at work and pursuing all of her usual activities.
This story illustrates the importance of pain specialists, who not only can assist with pain management but can make tremendous impacts on patients and their quality of life. Advancements in pain medicine are occurring at a rapid pace, and there is much more to come.
There are a few resources for you and/or your patients:
- CSA multimodal pain therapy video
- CDPH (California Department of Public Health): CA Overdose Dashboard
- California Department of Public Health, Opioid Prevention Initiative: https://www.cdph.ca.gov/Programs/CCDPHP/sapb/Pages/OPI-landing.aspx