Firstly, I want to thank Ms. Julie Mack of Mlive.com for reporting on this problem of using opioid painkillers.
I appreciate the sharing of findings from more than 40 Michigan hospitals and the letter published in the New England Journal of Medicine.
I have concerns about the research methodology and the evidence-based prescribing guidelines.
The central or core issue is the person, man or woman who may need pain relief with or without surgery. The research subject must be identified and be defined in scientific terms. Who is this research subject?
Everything that is born is constituted to experience the sensation called pain for man is a created being. It will be very difficult to defend the man's well-being if the appreciation of pain sensation is absent or diminished for any reason.
While pain is a fundamental attribute of the living condition, the living thing called man simply exists on account of the application of force commonly described as Providence, Mercy, Grace, or Compassion.
I speak of Compassion as a 'force' for it has an uplifting power. It provides additional energy to the person operating under its influence. I have experienced it and I have observed it. It is true to claim that the drugs are potent and affect bodily functions. It is equally true of Compassion. It affects both the caregiver and the recipient of the care provided.
The surgeon is able to perform the surgical procedure for the body begins to heal itself depending upon the natural healing process instituted by the Divine Healer, the original source of Compassion.
The story published in Mlive.com by Ms. Julie Mack does not mention a word about the role of compassion in healing and to secure pain relief.
Michigan study shows success in decreasing opioids without increasing post-surgical pain
Posted Aug 15, 8:00 AM
AP
This Feb. 19, 2013, file photo shows OxyContin pills arranged for a photo at a pharmacy, in Montpelier, Vermont
Michigan post-surgical patients sent home with a reduced number of opioid painkillers showed no difference in controlling pain compared to patients given more painkillers, according to a new study.
More than 40 Michigan hospital reduced by nearly one-third the number of opioid pills they prescribed to patients having nine common operations, from an average of 26 per patient to an average of 18, said a press release from Michigan Medicine at University of Michigan.
But the ratings those patients gave for their post-surgery pain and satisfaction didn’t change from the ratings given by patients treated in the six months before the opioid-reducing effort, according to a research letter in the New England Journal of Medicine.
In fact, patients reported that they only took half the opioids prescribed to them. Researchers attribute this drop in part to improved pre-surgery counseling about pain expectations and non-opioid pain control options.
The nine operations were: laparoscopic gall bladder removal, appendectomy, minor hernia repair, open ventral/incisional hernia repair, laparoscopic or open colectomy, and vaginal, abdominal or minimally invasive hysterectomy.
The research letter was written by Dr. Jocelyn Vu, a surgical resident at Michigan Medicine, and other members of Michigan Opioid Prescribing Engagement Network or Michigan-OPEN.
The study was a collaborative effort to help surgical teams follow evidence-based opioid prescribing guidelines developed at the University of Michigan.
The change in prescribing opioids comes in response to the nationwide opioid crisis.
The study includes prescription data from 11,716 patients who had operations at hospitals participating in the Michigan Surgical Quality Collaborative. Just over half of the patients also filled out surveys sent to their homes after their operations, reporting on their pain, satisfaction and opioid use after surgery, the press release said.
The Michigan-OPEN team has worked since 2016 to study the role of surgical opioid prescribing in the start of new persistent opioid-taking behavior among patients, and to quantify how prescription size relates to the number of opioids patients take, and their pain control, the press release said.
That research led to the development of evidence-based opioid prescribing guidelines first tested on gallbladder surgery patients at Michigan Medicine, before being expanded to other types of surgery.
In the time since the study ended, the Michigan-OPEN team has revised its surgical prescribing guideline to suggest even smaller prescriptions for these operations and has added over 15 other operations and procedures
Meanwhile, a Michigan law aimed at reducing excess opioid prescribing for acute pain took effect just after the study period, though the law allows for a much larger prescription than the Michigan-OPEN guidelines recommend.
MSQC is funded by Blue Cross Blue Shield of Michigan to improve surgical quality and safety across the state. Michigan-OPEN is funded by the Michigan Department of Health and Human Services and BCBSM and is based at the U-M Institute for Healthcare Policy and Innovation.
In addition to Vu and Englesbe, the research letter’s authors are Ryan A. Howard, MD; Vidhya Gunaseelan, MS; and Michigan-OPEN co-directors Chad M. Brummett, MD and Jennifer F. Waljee, MD. Englesbe, Brummett, and Waljee are members of IHPI.
I define Philosophy of Medicine as a systematic study of physical, mental, social, and spiritual aspects of man’s well-being in relation to health and disease using reflective methods characteristic of Philosophy. This is a systematic study of man as a physical, social, moral, spiritual, rational, and created being.
I am concerned with the status of man in the universe, in his natural environment, in his community, and as an ‘Individual’. Man has come into existence as an individual and he exists as an individual according to the Law of Individuality. Man’s existence is defended by his Immune System that deploys unique molecules( polymers ) that display Molecular Individualism.
Philosophy of Medicine while exploring the Nature of Human Existence provides the understanding of the vital connections that establish, maintain, and sustain Human Existence. Such understanding would provide a sensory experience called ‘MADHURYA’, a sensation of Sweetness which would enable man to function better, tolerate pain and suffering, and overcome obstacles. I am equally hopeful that Philosophy of Medicine would provide a bodily experience called ‘ANANDA’, a sense of Pure Joy, Bliss, and Contentment. The goal is not Enlightenment or Nirvana. The purpose would be to improve the quality of life and gain the experience of Whole Life.
Physicians are able to provide preventive, curative, restorative, and rehabilitative services because of the human body’s natural ability to heal itself. The repair process by which body heals itself is described as Inflammation and Repair. Human existence is possible because of this valuable, protective, natural healing mechanisms. This process and these mechanisms are not under man’s voluntary control. Indian thinkers have speculated that Physician(VAIDYA) could be equal to LORD known as Narayana, or Hari. It does not imply that a physician could be superhuman or could perform miracles.
A physician understands the natural mechanisms that assist healing and he could use them and manipulate them to provide a remedy or cure.
The physician could aim to get connected to the Divine Gifts of Healing that already exist and could seek a better outcome while treating a sick or injured person. The mechanism and the natural process could be identified as DIVINE.
Philosophy of Medicine will explore all these concepts and arrange the information into a meaningful pattern and interpret it to describe the Reality. The purpose of Medical Science is to describe and codify observations and experiences. My service in Indian Army Medical Corps had provided me the insights to understand and define Good Health and it would be my desire to keep people in Positive Health.
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