orm_november-2023 - 34

OR BUSINESS
BY DAVID COTRISS
Breaking down pain treatments in the OR and ASC
ain treatments
have applications
in traditional hospital
OR settings and ambulatory
surgery centers
(ASCs). " The choice of
setting depends on the
specific needs of the patient,
the type of procedure
being performed, and the resources
available, " says Wang Lushun, MD, senior
consultant orthopedic surgeon at
Arete Orthopaedic Centre in Singapore.
" Some patients may require repeated
treatments, while for others, a single session
may be enough. "
Sachin Narain, MD,
an anesthesiologist
and interventional pain
specialist at The Pain
Center of Arizona, finds
that ASCs are the best
places for these treatments
because they are
all outpatient, short proWang
Lushun,
MD
Sachin
Narain, MD
cedures. Blood loss is also very low
(often 5-10 mL or less). These cases
do not require general anesthesia and
can be done with sedation similar to
what is used for a colonoscopy, he says.
Pain treatment advantages,
disadvantages
The demand for these therapies is
driven by a variety of factors, including
the ongoing opioid crisis and the
increasing preference for minimally invasive
and non-pharmacological pain
management options.
Though these treatments can be expensive,
they can also provide significant
benefits in terms of patient comfort
and return to normal activities of
daily living, which can offset the higher
upfront costs.
Nerve blocks. Nerve blocks provide
targeted pain relief to specific areas of
the body, and can be used for chronic
pain and as an adjunct to anesthesia.
Nerve blocks can ease chronic pain
by offering immediate relief. They also
34
OR Manager | Nov/Dec 2023
P
can offer longer-term relief because
some injections reduce irritation to the
nerves and let them heal.
" Nerve blocks can also reduce the
need for general anesthesia, which can
have side effects and risks, especially
in patients with certain health conditions, "
says Dr Lashun. Additionally,
patients who receive nerve blocks often
have faster recovery times and fewer
side effects.
However, Dr Lashun notes, the risks
of complications are still possible, including
nerve damage, infection, and allergic
reactions. These risks are generally
low but can be serious if they occur.
He adds that nerve blocks are skill-dependent,
and their effectiveness can
depend on the skill and experience of
the practitioner administering the block.
Cryotherapy. Cryotherapy is the application
of extreme cold to freeze and
destroy tissue and relieve pain; players
in this treatment area include Pacira
and Iovera. It can be used for cancers,
skin conditions, and muscle and
ligament pain. Advantages include pain
relief and reduced inflammation, which
also arebeneficial for conditions like arthritis,
fibromyalgia, and sports injuries.
In a 2021 review, Klintberg and Larsson
from the University of Gothenburg,
Sweden, note that cryotherapy can be
used to treat chronic pain and swelling,
specifically in musculoskeletal injuries
and dysfunctions. " It is well tolerated
by patients, " they say. However, cryotherapy
treatments can be expensive,
and their accessibility varies by facility.
Cryotherapy also comes with a risk of
complications such as frostbite, nerve
damage, and breathing in nitrogen gas,
which can cause dizziness, confusion,
and even suffocation, and the evidence
for its effectiveness is not conclusive,
Dr Lashun notes. " Some studies have
shown no significant benefits, while others
have shown mixed results, " says
Dr Lashun. Additionally, more research
is needed to evaluate factors such as
procedure timing, cooling temperature,
and frequency of use to understand its
complete benefits or shortcomings.
Freeze nerve therapy. Also called
cryoablation of nerves, freeze nerve
therapy involves applying extremely cold
temperatures to nerves to temporarily
disrupt pain signals. The procedure
typically lasts 20 minutes to an hour depending
on the amount of nerves being
blocked. It is usually a safe procedure
that freezes the nerve that is transmitting
the pain to the brain. The results
can last several weeks to months.
Michael M. Duhon,
MD, MPH, a Californiabased
public health
consultant and internist,
says that freeze nerve
therapy can effectively
help with pain relief for
certain chronic pain conditions.
" It is minimally
invasive with quicker
Michael M.
Duhon, MD,
MPH
recovery and provides reversible treatment
with gradual return of nerve function, "
he says.
Listing some of the disadvantages,
Dr Duhon says, " Temporary pain relief
requiring repeat treatments, limited applicability
to specific pain conditions,
and potential complications such as
infection, bleeding, nerve damage, or
skin reactions can occur as a result of
the therapy. "
Additionally, this treatment may not
be effective for everyone. Patients who
haven't responded well to other similar
treatments such as diagnostic local anesthesia
nerve block may not find relief
in freeze nerve therapy.
Spinal cord stimulation. Spinal cord
stimulation helps people manage
chronic pain via an implantable device
that sends low levels of electricity directly
into the spinal cord to relieve pain.
Allen Burton, MD, divisional vice president
and chief medical officer at Abbott
Laboratories, Chicago, is an expert on
pain therapies. He says that patients
with many types of chronic pain find
spinal cord stimulation beneficial in imwww.ormanager.com
http://www.ormanager.com
orm_november-2023

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