Redefining Recovery: The Power of Prehabilitation and Non-Drug Pain Relief

Just a few weeks ago a peer reviewed article called “Advances in the Management of Acute Postsurgical Pain” was published(*).
The article is a review based on presentations by the authors at the meeting “Past, Present, and Future in Pain Medicine” held in May, 2023.

In this Blog we will discuss the promising aspects of non-drug pain relief and at the end you will find the take-aways from the publication.

It is clear that effective management of postoperative pain remains a huge challenge and because pain often is not treated adequately it sets the stage for developing chronic postsurgical pain. The conclusion of the authors is that in order to address this effectively, it requires improved clinical training of physicians and  better education of the patients before the surgery, in other words: improved prehabilitation.

 

The authors of the review article concludes that postoperative complications remain a concern, with around 8 million people dying globally post-major surgery and double that number experiencing complications. A significant post-surgical issue is inadequately managed pain, which can become chronic.

The full mechanisms and risk factors behind this transformation into chronic pain are still under investigation, emphasizing the importance of proper treatment for acute postsurgical pain. While there is much that still needs to be better studied and explored, the tools for managing postoperative pain are available; it's the willingness to use them that may be lacking.

While complexities in pain management is discussed in detail in the article, including the use of variations of drug combinations, it is surprising how little research digs into the adjunctive treatments and effects of non-drug alternatives.

The article suggest exploring “non-pharmacologic interventions, including physiotherapy, psychological support, exercise, massage, music therapy, laughter therapy and even alternative therapies like meditation and acupuncture, should be considered as part of a comprehensive, multimodal approach to postoperative pain management”. 

Of all these non-drug alternative methods, the power of pain relief achieved by using purpose-designed postoperative wound supports is not considered.

Why aren’t more physicians considering such methods?

 

It could be due to the reliance on traditional postoperative care methods or the lack of awareness about innovative products like QualiBreath, QualiBra Advanced and QualiBelly Advanced.

The article not only brings to light the importance of a well-rounded pre-surgical preparation but also emphasizes the urgent need for efficient post-surgical pain management. With the increasing acknowledgment of the important role of prehabilitation in surgical procedures, is it only a matter of time before more doctors consider non-drug alternatives as a staple in post-operative care?

In this scenario, solutions like QualiBreath, QualiBra Advanced and QualiBelly Advanced can play a pivotal role. With their unique design and functionalities, they provide non-drug pain relief post-surgery. They act as a support system, offering patients the comfort they need after surgery, reducing the dependency on pain medications.

Furthermore, recognizing the often-underestimated pain in pediatric patients, there is a specialized QualiBreath and QualiBelly Advanced for pediatric patients. This ensures that even our youngest patients get the best support during their recovery journey

Designed with the patient's comfort in mind, these wound support products can:

Direct Relief: By providing direct support to the surgical area, it reduces stress on the wound, which can significantly alleviate pain.

Enhanced Mobility: By providing support and stability patients are encouraged to move post-surgery which can be an effective strategy to speed up recovery and manage pain.

Breathing Assistance: Proper breathing can assist in pain management. The products facilitates better breathing, indirectly helping controlling pain.

The article based on the presentations from the meeting “Past, Present, and Future in Pain Medicine” leaves us with these conclusions and thoughts on how our products fit in perfectly:

• The article confirms how postoperative pain and chronic pain continue to be serious complications after surgeries worldwide.
  
  Designed to provide immediate comfort and pain relief, our products help alleviate the intensity and duration of postoperative discomfort, reducing the reliance on long-term pain medications.

• We see how the approach to address pain is still primarily focused on opioid medication. 
  
  By offering an effective non-drug alternative, our products have the potential to significantly reduce the dosage or frequency of opioid consumption, decreasing associated risks.

• The article confirms that opioid addiction increasingly leads to exploring multimodal pain-killing methods. 
  
  Serving as a reliable alternative and adjunctive method, our solutions can help to prevent the onset of opioid dependency, promoting safer post-surgical recovery paths.
  
  

• We also learn from the article that the effectiveness of ERAS (Enhanced Recovery After Surgery) protocols are being questioned. 
  
  With the medical community rethinking ERAS, our products are innovative solutions that can be integrated into new recovery models.
  
  
• It confirms that pediatric pain is under-treated and that myths about children and pain still exists.
  
  Recognizing this gap, we’ve developed specialized tools tailored for younger patients, ensuring their unique needs are addressed with the utmost care.
  
  

• We learn that the authors believe prehabilitation can be a solution to decrease postoperative pain.
  
  Our range emphasizes the importance of early intervention and proactive care, fitting seamlessly into prehabilitation regimens, enhancing their effectiveness.
  
  
• And finally, it shows how adjunctive non-drug pain-killing methods are largely ignored and un-explored in the medical field.
  
  

Our commitment is to spotlight and champion these underrepresented solutions. Our products fill this glaring gap, offering non- pharmacological relief, ensuring patients have a wider, more holistic set of options.

Postoperative pain management requires a multi-faceted approach.
As clinicians and researchers explore different strategies and methods, tools like QualiBreath, QualiBra Advanced and QualiBelly Advanced offer a ray of hope to patients.
By providing direct support, pain relief and ensuring better mobility and breathing, these products can be an invaluable tool in a patient's postoperative recovery journey.

• Note: Always consult with a medical professional when considering post-operative care methods.

 
Key insights from the publication:

• Approximately 80% of surgical patients undergo acute postoperative pain, with 75% rating it as moderate to severe.
  
  
• Even with a broad assortment of pain management options, many healthcare professionals remain uncertain about the most effective application of these treatments.
  
  
• Unaddressed acute pain can evolve into chronic postsurgical pain (CPSP) with its occurrence rate varying between 10-70% based on the type of surgery. Children are especially vulnerable.
  
  
• Guidelines on pain medication exist, but there is no universal approach to treat postoperative pain due to diverse patient conditions and varied surgeries. Ambulatory surgeries further complicate pain treatment.
  
  
• Epidural analgesia, commonly used for post-surgery pain, may hinder rehabilitation and interfere with Enhanced Recovery After Surgery (ERAS) protocols. Alternatives like peripheral nerve blocks, catheter wound infusion, and other local anesthesia methods are gaining traction, especially for outpatient procedures.
  
  
  

• ERAS protocols, designed to speed up post-surgery recovery, are facing scrutiny. Before ERAS was implemented the average hospital stay in the UK for knee replacements decreased from 5.8 to 3.7 days from 2008 to 2016. After the introduction of ERAS there was a slowed down decline, along with a slower rate of cost reduction. Critics believe ERAS's one-size-fits-all approach may be outdated due to advances in multimodal analgesia and local anesthesia.
  
  
• Even if there are clear benefits of local anesthesia approaches, they seem to be underutilized, particularly in orthopedic surgery.
  
  
• Informed consent mandates that patients be briefed on the risks and benefits of medical treatments, including surgeries. Many patients are ill-prepared. A study of 1,481 adult patients about to undergo surgery, 80% were not informed about the risk of chronic post- surgical pain (CPSP), with 25% claiming such knowledge might have influenced their decision about having surgery.
  
  
• Collaborative efforts among healthcare professionals are vital for postoperative pain management. Surgeons, anesthesiologists, and nursing staff all play unique and integral roles.
  
  
• Comprehensive pain relief requires balanced analgesics targeting multiple stages of pain perception. The World Health Organization recommends a tiered approach based on pain intensity.
  Multimodal analgesic strategies, targeting varied pain stages, show fewer complications and reduced hospital stays.
  
  
• Additionally, non-pharmacologic interventions, including physiotherapy, psychological support, exercise, massage, music therapy, laughter therapy and even alternative therapies like meditation and acupuncture, should be considered as part of a comprehensive, multimodal approach to postoperative pain management. 
  
  
  
  
• It's essential to assess patients' holistic health before surgery. Pain management education, pain level assessments, and tapering medications under supervision are key. Referrals to pain specialists might be necessary in some cases.
  
  
• Pediatric postoperative pain control is complex and often under-treated. There is a debunked but long-standing myth that children are unable to feel or recall pain. Some clinicians still believe that infants and children are unable to reliably express pain. This is far from the truth, although children do not always express pain in the same way that adults do. Children also do remember pain and such memories can cause short-term physiologic disturbances and longer-term behavioral changes.
  
  
• Effective pediatric postoperative pain treatment is hindered by clinician deficits in training. Physicians and nurses may underestimate pain in infants or overestimate opioid risks and many are uncomfortable with pediatric pain management.
  
  
• Pediatric pain assessment is foundational for effective pain control and validated tools like the Wong-Baker FACES scale, effective for ages five to 12 and sometimes younger should translate to quantifiable measures for clinical decisions.
  
  
• Surgery triggers two primary stress responses: the neuroendocrine and the inflammatory-immune responses. Post-surgery, patients face reduced functional capacity, which is more pronounced in malnourished or sarcopenic patients and can lead to complications or impaired recovery.
  
  
• Prehabilitation in perioperative medicine focuses on optimizing a patient's health before surgery. It integrates exercise, nutrition, psychosocial preparations, and medical optimizations. By enhancing a patient's health and fitness before surgery through prehabilitation, one can minimize post-surgery functional loss and ensure swifter, more effective recovery.
  
  
• A multidisciplinary team, consisting of professionals such as case managers, nutritionists, psychologists, physiotherapists, and surgeons, ensures the success of prehabilitation. Benefits include faster recoveries, fewer complications, and reduced costs. Challenges to its wider acceptance include high standards and external interruptions.
  
  
  
  
• Prehabilitation offers numerous benefits, but its broad integration into clinical environments presents hurdles. Research indicates that many patients couldn't finish the prehabilitation regimen due to demanding participation criteria, transportation barriers, or disruptions from other medical treatments. Yet, those who did complete it, particularly those set for major operations, experienced significant advantages like shorter hospitalizations and notable cost reductions. Proposals have been made to address these issues, aiming to enhance the efficacy and uptake of prehabilitation in medical facilities.

Reference

*Paladini A, Rawal N, Coca Martinez M, et al. (August 04, 2023) Advances in the Management of Acute Postsurgical Pain: A Review. Cureus 15(8): e42974. doi:10.7759/cureus.42974).