Wendy G. Anderson, M.D.: Better communication makes for better pain management

Question: When should a palliative care consult happen?

Dr. Anderson: There are two specialty consult services that are important to think about: the pain-management consult services for acute and chronic pain, and the palliative care consult service, for patients with serious illnesses. There are also outpatient services available for both of those. One of the big pieces of this project has been raising awareness for hospitalists about what resources are available if a patient’s pain isn’t well controlled or if the patient isn’t satisfied with their pain management.

We’ve really been encouraging hospitalists to consult the pain management or palliative care consult service when they have patients in whom they have tried something and it hasn’t worked, or if a patient is having readmissions for pain. Oftentimes, patients are discharged home and have to come back in because they didn’t have an adequate pain-management plan as an outpatient. Those would be patients for whom it’s really important to develop a plan with the primary care provider and to consider referring to outpatient palliative care or pain management.

Question: How do you get patients more engaged, and what are the benefits in doing that?

Dr. Anderson: I’ve met very few patients that don’t want to be engaged when it comes to their pain management. So we, as physicians, need to partner with them and ask them which medications have worked and which haven’t. We need to be open to them having some input into their pain regimen.

In some cases, we may not have a medical explanation for why one medication works better for a patient. If it’s a reasonable medical plan and there are two options for patients to choose between, it helps them to have control over their medications and to feel like they’re involved in their treatment. Just ask about what has worked for them before for their pain. Do they have other ideas for things that they might want to try? They really are the experts. When a patient says that only a certain medication works for them, we tend to disbelieve them. But there’s been a lot of interesting research that has come out recently that shows that people actually do have different genetic opioid receptors. So it may actually be true that some of the medicines don’t work for them. Listening to them, and involving them in the plan, within medical reason, is really important.

mschneider@frontlinemedcom.com

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