In this article, Andrew Churnside, sales and marketing director at CME Medical UK, explores the history of pain management and how the market is expected to change in the future, concluding that patient comfort will determine a new generation of pain management technology
Earliest records of treatment for pain included pressure, heat, water, and sun, while the relief of pain was the responsibility of sorcerers, shamans, priests and priestesses who used herbs, rites and ceremonies. Thankfully things have moved on dramatically since then, with patient safety and comfort at the top of the pain management agenda.
It was not until the 19th Century that pain came to live under the domain of science, paving the way for advances in pain therapy. Today’s modern pain management makes the most of the latest technology to ensure patient comfort and to help recovery.
For the past two decades the classic scenario in many hospital wards has been of a patient lying passively in bed while hooked up to a syringe pump attached to a tall drug stand. Nurses would attend to the pump, with annoying beeps regularly sounding. This is still the case in many wards.
Using technology to aid recovery
The technology used to deliver pain relief is changing rapidly and is now following the pathway of improving patient comfort, with the acknowledgement that getting people up and out of bed can help them to recover more quickly. Nowhere is this more evident than at the Manchester and Salford Pain Centre.
Martin Howarth is a specialist pain nurse who has been working at the centre since 2001 as part of an interdisciplinary team. He explains: “We have been using specialist infusion pumps for pain management for the past 18 years.
It was not until the 19th Century that pain came to live under the domain of science, paving the way for advances in pain therapy
“All of our patient-controlled analgesia (PCA) care on the wards involves using compact, battery-operated technology. From a recovery perspective it is important that the PCA can be used when the patient is ambulatory, in fact when we are teaching our staff, we encourage them to ask the patients to mobilise. Therefore being able to put the pump in a specially-developed carry bag with a shoulder strap is ideal.”
The key word here is ambulatory – giving patients who are well enough, the option to get out of bed and move around - which is something they can not do very easily when attached to a large drip stand. The latest infusion devices which are portable and discreet, give patients a level of choice and eliminate the physical restrictions of the past.
For example, a patient can carry a modern ambulatory pump in a bag on their shoulder and walk to the physiotherapy department to work with the physios as part of their recovery, and then go for a coffee afterwards. It can make a big difference to a patient’s quality of life on the ward. Furthermore, patients who are not stuck staring at four walls will feel better psychologically. If they can get up and about it is a sign of progress in their own minds and can help them to feel they are getting better.
From a safety perspective modern infusion pumps, such as CME’s BodyGuard products, have a range of controls so that patients and relatives are unable to change them or cause a risk of overdose. The worst scenario would be to turn off the medication and if that were to happen, it would trigger an alarm.
A multi-disciplinary approach
This combination of improved technology and the recognition of the psychological factors of pain management has led the team at the Manchester and Salford Pain Centre to take a unique interdisciplinary and holistic approach to patient comfort and safety. The centre is one of the country’s leading clinics for the management of all forms of pain and is a national centre for excellence in the delivery of interdisciplinary pain management programmes (PMP).
The key word is ambulatory – giving patients who are well enough the option to get out of bed and move around - which is something they can not do very easily when attached to a large drip stand
A PMP is a group rehabilitation programme for patients who are suffering from chronic pain, i.e. pain that has lasted for more than six months and remains unresolved despite a variety of treatments. It can often affect many areas of life including work, social life, home life, mood and sleep.
Usually eight to 10 patients attend each PMP and the programme team comprises a clinical psychologist, physiotherapist and medical doctor, all of whom specialise in the management of chronic pain.
Overall the aim of the PMP is to help the patient focus on self management, helping them to address both the physical and emotional impact of chronic pain on their life. The programme uses well-established, evidence-based cognitive behavioural therapy (CBT) approaches throughout all sessions. Activities include information and education about pain and pain management, a structured graded exercise programme, goal planning and sleep management.
There is strong evidence for the efficacy of both outpatient and inpatient cognitive-behavioural PMPs as a package compared with either no treatment or standard treatments. Analysis of Manchester & Salford Pain Centre outcome PMP data demonstrates statistically and clinically significant improvements across a range of standardised measures.
attending PMPs can expect improvements in interpersonal relationships, reduced depression and anxiety, increased physical fitness, an increased likelihood of work retention or readiness to return to work, optimised medication use, and a reduction in healthcare use.
Patient safety improvements
One of the biggest advantages of modern pain relief delivery devices is the added layer of patient safety they offer through pre-programmed protocols and lockable key pads. These functions not only reassure staff, but they help to ensure patients are comfortable and happy to use the devices on their own at home, without fear of overdose or addiction.
Howarth said: “The ‘lock-out’ system of the infusion pump we use allows patients to administer up to 12 doses every hour - one dose every five minutes if required - but helps prevent potential overdosing. This is particularly reassuring for the ward staff as they know exactly how much the patient is receiving and the pump can be interrogated, providing the clinician with an accurate record of how much analgesia has been received over a specific time frame.
“Recently I had a patient who was concerned about the risk of an overdose and addiction prior to using the pump. However, once it had been clearly explained and the lock-out safety feature had been demonstrated, they were reassured about using its use. As a result they received more effective pain control following their surgery.”
He added: “The built-in protocols of the BodyGuard 575 Pain Management Infusion Pump we use are tailored to the needs of the acute pain team and can only be accessed by trained personnel. For example the lockable keypad prevents inadvertent pressing of the buttons and there is an intuitive LCD screen.
The picture of pain management is already changing from the bedridden patient attached to a cumbersome drip stand, to a mobile patient carrying a small portable pump
“The fact that the doses are predefined makes it much easier and quicker to set up the right programme, which is critical on our busy wards. Staff are trained to identify the various programmes and if the prescription is changed they are able to reprogramme the pump choosing the correct set protocol.
“We also use a bag-based system, where pre-filled bags are attached to the pumps with the infusion lines colour-coded to match the pumps. This system saves time, is easy to use and is beneficial from a safety point of view as we know the contents are sterile, however it takes a well-organised team to manage this. The management of the pumps is an established process undertaken by a dedicated pharmacy team.”
Information and data on how much medication a patient has received is vital for the successful management of patients on a busy ward. Using the latest infusion technology means the staff at the Manchester and Salford Pain Centre are able to monitor the graphs produced by the pump, which tell them exactly how much drug a patient has been given, or needs.
Howarth said: “The graphs show us whether we need to increase or decrease the dose of the bolus being given to the patient. They also enable us to convert to an oral route more confidently by obtaining an accurate figure of how much analgesia has been used over a 24-hour period and then calculating an equal oral dose.”
With improved technology comes a need for increased staff training to ensure everyone on the ward is fully up to speed with all the pain delivery systems and the provision of training is now an issue all modern hospitals consider when looking to purchase new equipment.
Howarth said: “It was imperative that we were provided with a good training programme when we purchased our infusion pumps. As with any new piece of equipment there is always a degree of anxiety or uncertainty on how to use it. To ensure that staff are confident in the management of the infusion pump the competency assessment process is vital.
He added: “Pumps are the mainstay of pain management and our choice has meant we have been able to ensure the highest possible standards of patient care in our busy hospital.”
The picture of pain management is already changing from the bedridden patient attached to a cumbersome drip stand, to a mobile patient carrying a small portable pump.So what could it look like in the next 10 years?
The clear aim is to bring people into a building, make them better and send them home as soon as possible where they can safely manage their own pain using a delivery system which targets the very specific area of pain instead of a generic pain blocker
Imagine being able to send your patient home several hours after an operation, with their own medication infusion device which you have pre-programmed for them, which they can carry in a specially-designed rucksack with absolute confidence.
The smart drugs inside it target only the area operated on, leaving the patient free to carry on with their everyday life as normal, just pressing a button for pain relief as and when they need it. Every time they do, the pump connects through their wi-fi service and sends the data back to a central monitoring system. If there are any issues an alert is raised and the patient recieves a phone call from the telehealthcare team offering advice and guidance.
This is the picture being painted currently at the future of pain management conferences around the world. The clear aim is to bring people into a building, make them better and send them home as soon as possible where they can safely manage their own pain using a delivery system which targets the very specific area of pain instead of a generic pain blocker.