The Recuperative Pain Medicine Service (RPM)

This new In-Patient service has been established here at HSS to work in conjunction with the Acute Pain Service (APS) and Chronic Pain Service to provide safe and effective pain management to all patients from the time they are transitioned from their PCA (patient-controlled analgesia) pump to oral pain medication, monitoring their pain level until they are discharged from the hospital.

The RPM service is committed to reducing post-operative pain and ensuring that all patients are placed on an oral pain medication regimen that adequately controls their pain both here in the hospital and while recovering from their surgery at home. If a pain medication is not effective, or causing unwanted side-effects for the patient, the RPM service is consulted and will make the necessary changes to the medication regimen.

The RPM service consists of a specialized team of clinicians with expertise in post-operative pain management, including an anesthesiologist and a nurse practitioner. The RPM service works very closely with the surgeon, the nurses, the Acute Pain Service, the physical therapists, and the social services department to ensure that a comprehensive and patient-specific discharge plan (including pain management) is in place for each patient, both during their stay at HSS, and when they leave the hospital.

The RPM service also provides patient education about pain management and the pain medications being used. The nurse practitioner on the RPM team will see every patient on the service once or twice daily. If the patient is well controlled on pain medications after transitioning from their PCA pump, the RPM service will see that patient on the day of their discharge to provide pain education and answer any pain management questions the patient or their family may have.

 

FAQ's

1. What is the VAS scale, and how do I use it when explaining to the staff what my level of pain is?

A. The VAS (Visual Analog Scale) is a horizontal line with words at each end of the line which say either “no pain” or “worst possible pain”. Between the two words are a series of numbers from 0 (no pain) to 10 (worst possible pain). Based on what you feel as your level of pain on the 0 to 10 scale, you will inform the nurse of this number, and pain medication will be given accordingly. The VAS scale is a very important tool we use here at HSS. Since pain is different for each and every person, only you are able to tell us what you are feeling. The number you give to rate your pain is important as it helps the staff know if the pain medication you are getting is working well enough to keep you comfortable. A “comfortable” number is usually a VAS score of 3-4. Here is an example of the VAS scale:

2. How much pain should I expect with my surgery?

A. No matter what surgery you are having, you WILL experience some discomfort/pain. The amount of pain you will have is different for every person, no two people are alike. No matter what level of pain you are having following your surgery, the Pain Management team will be working hard to get your pain under control. Generally, a pain level of 3-4 on the VAS (see above FAQ) or less is tolerable, and will allow you to perform physical therapy and perform daily activities with minimal limitations. Our goal in pain management is to get you to a pain level of 3-4 or less. Unfortunately, we cannot take away the pain completely, only time and healing will do that. But rest assured that we will make you as comfortable as possible to get you moving toward recovery.

3. How long does it take for PCA (Patient Controlled Analgesic) or pain pills to start working? How long does each last?

A. Generally, after pushing the button on the PCA, initial relief of discomfort can begin in as little as 5 minutes. The PCA medication kicks in quickly but usually lasts for only a few hours – a much shorter time period than oral pain pills. Oral pain pills dissolve in the stomach so they take between 30 to 45 minutes to start working from the time they are swallowed. Because these pills slowly dissolve in the stomach, they generally work to control pain for 3 to 4 hours at a time.

4. How do I get my pain relief pills while in the hospital?

A. All oral pain medications are ordered for patients on an “as needed” basis due to regulations. Pain medications are NOT distributed automatically by our staff. This means that each patient is responsible for asking for their pain medications throughout the day at scheduled times, or when you are experiencing an increase in pain. Your assigned nurse will be routinely checking your pain status throughout your stay here at HSS, but it is important that you keep on top of your pain medication and ask for it every 3 to 4 hours in the immediate period following your surgery. This will ensure that you are more comfortable throughout the entire day.

5. What are the most common pain medications (pills) that are prescribed?

A. The most common pain medications in pill form used here at HSS are Vicodin or Norco (hydrocodone/acetaminophen) and Percocet (oxycodone/acetaminophen). Depending on your pain level, both are very effective, and have few side effects. It is common that you may be started on one of these medications, and then changed onto another.

6. How long will I be on pain medication?

A. Generally, our patients are on pain medication for a few weeks. There is no exact timeframe, since everyone progresses at a different pace. Most patients find that they are taking their pain pills more often throughout the day for the first one to two weeks, then after some healing time and physical therapy, they require less frequent dosing, and eventually stop the pain medication at about 4 to 6 weeks after surgery.

7. What are the side effects of the pain medications?

A. The most common side-effects of pain medications are: drowsiness, dizziness, light-headedness, nausea, vomiting, constipation, dry mouth, sweating, and itching. Most of these side-effects are mild, and can easily be controlled with medications while here at the hospital. A rash is NOT an expected side-effect, and may be an indication that you are allergic to the medication you are taking – if this happens, please tell your doctor or hospital staff (RN) immediately.

8. Will I become addicted to the pain medications?

A. It is very rare that patients will become addicted to pain medications following their surgery. Long term use (many weeks to months) may increase your risk of getting used to a current dose of medication so that it is no longer enough to control your pain and you would need to increase the dose in order to get pain relief. Almost all patients undergoing routine orthopedic surgery need pain medications for only a short time, therefore the risk of dependence or addiction is very low.