# Reassessing Pain Management: A Comprehensive Strategy to Decrease Opioid Reliance

### By Dr. Myles Gart, Anesthesiologist

Pain management has traditionally been influenced by a single, oversimplified measurement: the Numeric Pain Scale (NPS). Patients express their pain on a scale of 0 to 10, and clinicians typically respond—often by prescribing opioids. However, in a context where the United States accounts for 80 percent of global opioid consumption, despite representing only 4.4 percent of the worldwide population, it becomes evident that this strategy has significant repercussions.

At my hospital, we challenged this status quo by implementing a **multimodal pain evaluation approach**—yielding remarkable outcomes. We **reduced inpatient opioid consumption (quantified in morphine milligram equivalents, or MMEs) by 50 percent** while ensuring effective pain management. This strategy not only enhanced patient safety but also transformed expectations regarding pain relief, particularly after discharge. It is imperative to establish multimodal pain assessment as the national norm.

## The Flaw in the Numeric Pain Scale

The NPS appears straightforward: ask patients to rank their pain from 0 to 10, then adjust treatment based on that. Yet, when relied upon exclusively, it contributes to **opioid overprescribing**.

– Research indicates that **NPS-driven protocols lead to 20–30 percent additional opioid use than necessary**.
– The Joint Commission’s **2012 Sentinel Event Alert #49** identified dosing errors as responsible for **47 percent of opioid-related adverse events** occurring from 2004 to 2011.
– In 2022, **7,407 inpatient opioid overdose discharges** were reported nationally (NHCS data), implying that **hundreds—possibly thousands—might have been avoided** with improved prescribing methods.

## A Multimodal Strategy: Moving Beyond the NPS

Acknowledging these shortcomings, my hospital **combined the NPS with objective clinical indicators** to ensure a more thorough management of pain:

✅ **Respiratory rate and sedation evaluations** – to determine opioid sensitivity.
✅ **Functional capability assessments** – centering on mobility and daily activities, rather than merely eliminating pain.
✅ **Medication history and opioid tolerance** – to safely modify dosing.
✅ **Broader non-opioid options** – including **regional nerve blocks, NSAIDs, acetaminophen, and physical therapy**.

Through the integration of these techniques, we **halved inpatient opioid consumption** while still achieving effective pain control. These findings align with broader research indicating that **multimodal pain management reduces opioid use by 30–50 percent**.

## Beyond the Inpatient Arena: Transforming Outpatient Expectations

One of the most striking outcomes of our revised protocol was its effect on **post-hospital pain management**. Conventional care models often foster **unrealistic expectations among patients**, where even **moderate pain (3–4/10) is viewed as intolerable**—leading to prolonged opioid use.

After implementing multimodal pain strategies:

– **Patients left the hospital content with a pain level around 3/10**, recognizing that some discomfort is normal and can be managed without opioids.
– Research corroborates this impact—**6–10 percent of surgical patients (8,000–13,000 of 135,000 each year) transition to chronic opioid users post-discharge** due to excessive inpatient prescriptions. We noted declines by establishing realistic expectations from the start.

## Why This Must Become National Policy

The U.S. opioid epidemic requires **policy measures**, not just isolated hospital efforts. The **disproportionate ratios of opioid consumption** worldwide illustrate a clear issue:

🟢 The U.S. consumes **99 percent of the globe’s hydrocodone and 83 percent of its oxycodone (STAT News, 2019)**.
🟢 Germany, employing a **multimodal-first methodology, utilizes only one-tenth of the opioids per capita in contrast to the U.S.**

Our hospital’s accomplishments demonstrate that it is feasible to **reduce opioid intake without sacrificing pain control**. Now, it’s crucial for lawmakers and medical organizations to act:

1️⃣ **Establish multimodal pain assessment as a nationwide requirement** – mandating hospitals to incorporate NPS with functional and objective measures.
2️⃣ **Encourage non-opioid pain management approaches** – including expanding insurance reimbursement and provider education on multimodal techniques.
3️⃣ **Set national opioid reduction objectives** – aiming for a **25 percent decrease in inpatient opioid usage** within five years, a target supported by real-world data.
4️⃣ **Educate patients on functional pain goals** – to minimize outpatient dependence and reduce **post-discharge opioid consumption by 10–20 percent** nationwide.

## The Conclusion

I have witnessed firsthand the potential within rethinking pain management. Through a **multimodal approach, our hospital successfully reduced inpatient