[Music]
hi so welcome and you said my name is
Meredith drainie and I’m here to talk
about something that I’m very passionate
about I love my job I’m passionate about
it I’ve learned a lot about talking to
people helping me some anxieties and
fear of the unknown and managing pain
and managing expectations so gained a
little bit of a different perspective I
think I’m very birdly honest with my
patients sometimes so much so that it
puts them off initially until they kind
of get the program and get what I’m
saying and wrap their head around it so
just want to share a little bit about
what I’ve learned with you this doesn’t
want to start off by saying that pain
does not have to control you there are
millions of people every single day
dealing with pain in some aspect in some
form in some regard physical pain mental
pain emotional pain in my area in my
world in the hospital where I see
surgical pain it’s primarily what we’re
talking about people come in for surgery
and have an operation it hurts we fix
them we send them home right that’s
anyhow but it’s not just the pain itself
that we struggle with it’s the fear of
the unknown
the anxiety that’s surrounding this pain
that’s the real struggle that’s what we
have to overcome and contend with
especially people they’ve never had
surgery before maybe they’ve never
encountered something that’s so
traumatic or so problematic they don’t
know how to process this amount of pain
I don’t know what to expect
part of the key or the whole key with
this solution is removing the barriers
because pain is unavoidable but it does
not have to control you so like Nick
said every week I stand up and I talked
to 18 patients and their family members
and their caregivers and I try as hard
as I can sometimes it’s harder than
others sometimes it’s a little bit
harder than others to try and convince
them that what they’re going through is
okay and it’s not going to kill them
we’re all gonna get through it but we
take this time and talk about the whole
surgical process so we talked about prea
post-op what’s a pack in their overnight
bag what tests they have to do
beforehand to get ready for surgery
what the members are on a team that are
going to be taking care of them what the
physical therapy part of surgeries like
both after and when patients
at home so I’ve done about 70 of these
talks in my current role
so I’d say I have it down to a pretty
good science as far as the amount of
time we spend on each topic cuz I only
have about sixty five minutes to get my
point across to make sure we’re all on
the same page and everyone’s feeling
really good when they walk out those
doors so of all the topics that we talk
about and then number one singular topic
that devotes the most time and attention
it’s pain management that’s when you see
a still graph up here old question mark
up there that little sliver that’s
unidentified it’s pain management that’s
the most amount of questions that I get
people don’t ask things like what
exactly happens on surgery my doctor
didn’t explain it well or I really want
to have my wife or husband spend the
night with me cuz I’m anxious is that
allowed or hey what’s the password is a
free Wi-Fi because that’d be my question
about that I’m searching and I get those
questions sometimes but usually the
questions are about paying people ask me
is it going to her after surgery I’ve
had I told my doctor that I don’t want
to feel any pain after surgery I don’t
want it to hurt I told him I’m telling
you who else do I need to tell to make
sure that happens how bad does joint
replacement hurt get all of these
questions all the time and sometimes I
laugh and the whole class was together
and I answer the same way yes this is
going to hurt it is going to be
uncomfortable you are going to get
through it will you be in agony no are
you going to suffer absolutely not
it’s your entire medical team going to
do everything they can to take care of
you
and manager pain in a responsible
conservative way yeah definitely and are
you going to get through it absolutely
and here’s how we are going to set
realistic expectations that’s step one
anytime you’re talking about pain again
no matter what kind of pain you are
experiencing if you’re having surgery if
you’re going through divorce if you just
got fired from your job it is going to
hurt it is going to be painful it’s not
pretty and nice I mean when is it ever
but if you can accept that and wrap your
head around it I promise you you’re
going to be so much better off and it’s
when I say that that I see people’s
faces start to soften and it’s kind of
this aha moment where they go okay well
yeah at least she was honest it’s gonna
hurt a little bit but it’s gonna be okay
two days later I’ll be home and then
I’ll get beyond it so studying realistic
expectations it’s the number one key and
overcoming this hurdle and complicated
pain management okay when you think
about realistic expectations whenever
you set them too high or they’re not
based in reality
they are often unmet did you know that
people say anyhow it’s pretty common
that unmet expectations are the number
one reason for divorce yeah I believe it
makes sense unmet expectations lead to
dissolution of the
they lead to people sniffing their tab
for a nice expensive dinner because it
didn’t meet their expectations of the
quality met expectations can kill your
sex life mmm by in my world unmet
expectations lead to poor patient
outcomes patients are just satisfied
they’re discouraged in their providers
and themselves and their recovery so if
we set those realistic expectations from
the beginning outline what’s gonna
happen and how real it’s going to be
it’s a night and day difference
so once we’ve set those expectations the
next step in the process is trying our
best to reconcile perception with
reality so we have this little scale
here we use this at any Hospital if
you’ve ever been in the hospital or the
doctor’s office and last 10 years you’ve
probably seen it so this is a skill we
use to let patients measure and then not
have pain they’re having now the scale
is pretty basic when you look at it okay
it’s simple
zero is no pain right 10 is the worst
pain possible attending right up there
by the little frowny face with the tears
coming down where’s maybe possible so
this does not mean the worst pain
compared to last like an hour ago when
we asked you or the pain compared to
yesterday when you first hurt yourself
or first sustained an injury this is the
worst paying possible that you could
ever experience or an indoor in your
entire lifetime so when we put it in
that perspective and explain it to
patients in a way they can understand
it’s another aha moment suddenly 10 out
of 10 seems a little silly right because
it’s a hangnail so it’s probably not the
worst pain that your and we’re going to
in your lifetime if it is good for you
because you live a really nice life
so when we marry in that perception with
reality our our outcomes are better when
you are able to perceive what is
happening to you and that sort of scale
and you can put it into context you
actually require less energy to overcome
what you’re going through
it becomes less traumatic less of the
fight less of a struggle when you can
perceive it and understand it and see
how it fits with the expectations that
you had going into whatever you’re
experiencing
here’s where it gets a little tricky the
expectations have been said our
perception is based in reality the next
step in the process is treatment okay
because everybody’s pain is subjective
that’s a really huge take away with this
everybody’s going to experience things
differently
your hangnail might be the worst thing
you’ve ever experienced right but this
guy’s broken ankle is way worse okay or
he thinks you’re hanging out was really
bad and his ankles not that bad so
everybody’s perception is going to be a
little bit different the problem with
our healthcare today is that pain is
subjective and treatment is not
treatment is objective if this then that
if your pain is a six here’s what you’re
going to get so that’s where people in
patients have to take ownership in what
they’re experiencing and going through
so that way their treatment is actually
appropriate for what they’re
experiencing so in my case a lot of the
treatment is medication related but it
also is things like massage or touch
therapy sometimes we do nutritional
coaching or weight loss coaching for
arthritis type pain distraction
techniques relaxation that sort of thing
but if you have been abreast of the news
and you know what’s going on in the
world today it’s pretty easy to think
about how the majority of people
associate pain with narcotic medication
I’m in pain I want it drugs that’s the
culture that we have grown into and I
want to explain why and how this came
about and what we’re doing and trying
so in 1991 something happened that
started us on this upward trend of
opioid use so this graph illustrates the
amount of opioid prescriptions that were
filled at commercial pharmacies between
1991 and 2013 anybody have any guesses
what happened in 1991 in the medical
community regarding pain that started
this upward trend
anybody know know yeah I’ve got somebody
in the back has an idea pain as the
fifth vital sign thank you that’s
correct so in 1991 the American Pain
Society came out and said in a response
to patients having pain in the hospital
than surgery we want to do something to
make sure that they’re getting really
great care so we are going to declare
that pain should be a vital sign if we
aren’t sure what vital signs are we’re
talking about things like heart rate
blood pressure the amount of
respirations you take per minute so
these are things that keep you alive so
when pain to the fifth vital sign is
introduced all of a sudden providers on
every single encounter are assessing
patients for pain and asking what is
your level of pain on a scale from zero
to ten so when you have a situation like
that and you have a patient population
if they’re lacking the education on
these expectations and their perception
of reality on this scale of 0
the 10 of course they’re gonna say yeah
I’m gonna ten out of ten
I want those really good drugs this
hangnail is killing me and I’ve been in
the ER for nine hours and I could use
some dilaudid so that’s how this process
started so without proper education
without patient awareness of the risks
and the side effects of these
medications the use of these opioid
prescriptions started to skyrocket
between 1991 and 2013 these
prescriptions a percentage rate of use
went up a hundred and seventy two
percent a hundred and seventy two
percent increase in the amount of opioid
prescriptions being filled at pharmacies
in this time frame so this is the battle
that we are now fighting what’s
happening is healthcare providers are
now trying to backpedal and go wait wait
wait wait wait wait maybe it wasn’t such
a good idea we need to assess pain maybe
not so rigidly but we need to look at it
another way so we’ve started to do non
pharmacological means of managing these
patients pain all these other things I
mentioned like sometimes nerve
stimulators for back pain and you sort
of light therapy for migraines anything
new and upcoming that’s not a narcotic
with these heavy side effects so the
medical community is spending millions
on research trying to figure out ways
that we can manage pain without causing
all of this high opioid use and that an
opioid epidemic and addiction that we’re
seeing now so I don’t know about you but
I find it strangely ironic that now
we’re trying to revert back to the pain
method that we used before all this
started and said
probably wasn’t such a good idea so
that’s a lot of what we’re doing in my
job anyhow to try and find alternatives
that get us out of this situation that
we’ve created and I don’t know you can
see this very well but I should probably
point out that that denominator is in
millions so that number in 2013 is 207
million prescriptions so our the problem
so what we have found in our program
have we kind of bring this all together
is that for this education piece through
helping patients understand these
expectations and set them from the
beginning and let them know what they’re
in store for and what’s coming ahead
when we do that help them understand the
scale and ground their perception in
some realm neighborhood of reality and
then find a treatment that’s
conservative as possible while still
managing their pain and keeping them
comfortable after surgery when we take
all those things combined we’ve
increased our satisfaction scores
meaning the amount of patients that say
they’re satisfied with their pain
management after surgery it was exactly
what they expected and they got what
they were looking for for their
providers by doing all of that we
increase the percentage of satisfaction
from 42 to 90 percent which is
incredible 90% of patients after surgery
saying yeah you know I knew what all
this ahead of time it’s exactly what I
was expecting so this knowledge not only
is great for the satisfaction of
patients
more important to me especially these
individuals are grateful they come to me
and they come to their providers and say
thank you thank you for giving us this
knowledge that helped bridge that gap
between the unknown and reality it took
away my fear and it took away my anxiety
so when we apply those principles across
the spectrum because as I’m talk about
paying in a hospital because that’s my
specialty like I said in the beginning
pain is not limited to the hospital
we’re talking about pain that you
experience every day divorce loss of a
loved one you know getting fired from a
job or losing a promotion that you’ve
been working so hard for for the last 10
years it’s all painful we all experience
pain on some different level but if we
set our expectations a reasonable level
we perceive what’s happening to us in a
realistic way I’m lucky enough to have
somebody there to kind of walk us
through it and we have better outcomes
pain is you know no different whoever
you’re talking to I mean I’ve been
willing to guess that the pain of a
broken arm probably using that much
different and then pain of a broken
heart okay
pain is unavoidable but it does not have
to control you and with my patients it
does not have to control their recovery
so that’s what I wanted to share with
you today thank you
you
you
hi so welcome and you said my name is
Meredith drainie and I’m here to talk
about something that I’m very passionate
about I love my job I’m passionate about
it I’ve learned a lot about talking to
people helping me some anxieties and
fear of the unknown and managing pain
and managing expectations so gained a
little bit of a different perspective I
think I’m very birdly honest with my
patients sometimes so much so that it
puts them off initially until they kind
of get the program and get what I’m
saying and wrap their head around it so
just want to share a little bit about
what I’ve learned with you this doesn’t
want to start off by saying that pain
does not have to control you there are
millions of people every single day
dealing with pain in some aspect in some
form in some regard physical pain mental
pain emotional pain in my area in my
world in the hospital where I see
surgical pain it’s primarily what we’re
talking about people come in for surgery
and have an operation it hurts we fix
them we send them home right that’s
anyhow but it’s not just the pain itself
that we struggle with it’s the fear of
the unknown
the anxiety that’s surrounding this pain
that’s the real struggle that’s what we
have to overcome and contend with
especially people they’ve never had
surgery before maybe they’ve never
encountered something that’s so
traumatic or so problematic they don’t
know how to process this amount of pain
I don’t know what to expect
part of the key or the whole key with
this solution is removing the barriers
because pain is unavoidable but it does
not have to control you so like Nick
said every week I stand up and I talked
to 18 patients and their family members
and their caregivers and I try as hard
as I can sometimes it’s harder than
others sometimes it’s a little bit
harder than others to try and convince
them that what they’re going through is
okay and it’s not going to kill them
we’re all gonna get through it but we
take this time and talk about the whole
surgical process so we talked about prea
post-op what’s a pack in their overnight
bag what tests they have to do
beforehand to get ready for surgery
what the members are on a team that are
going to be taking care of them what the
physical therapy part of surgeries like
both after and when patients
at home so I’ve done about 70 of these
talks in my current role
so I’d say I have it down to a pretty
good science as far as the amount of
time we spend on each topic cuz I only
have about sixty five minutes to get my
point across to make sure we’re all on
the same page and everyone’s feeling
really good when they walk out those
doors so of all the topics that we talk
about and then number one singular topic
that devotes the most time and attention
it’s pain management that’s when you see
a still graph up here old question mark
up there that little sliver that’s
unidentified it’s pain management that’s
the most amount of questions that I get
people don’t ask things like what
exactly happens on surgery my doctor
didn’t explain it well or I really want
to have my wife or husband spend the
night with me cuz I’m anxious is that
allowed or hey what’s the password is a
free Wi-Fi because that’d be my question
about that I’m searching and I get those
questions sometimes but usually the
questions are about paying people ask me
is it going to her after surgery I’ve
had I told my doctor that I don’t want
to feel any pain after surgery I don’t
want it to hurt I told him I’m telling
you who else do I need to tell to make
sure that happens how bad does joint
replacement hurt get all of these
questions all the time and sometimes I
laugh and the whole class was together
and I answer the same way yes this is
going to hurt it is going to be
uncomfortable you are going to get
through it will you be in agony no are
you going to suffer absolutely not
it’s your entire medical team going to
do everything they can to take care of
you
and manager pain in a responsible
conservative way yeah definitely and are
you going to get through it absolutely
and here’s how we are going to set
realistic expectations that’s step one
anytime you’re talking about pain again
no matter what kind of pain you are
experiencing if you’re having surgery if
you’re going through divorce if you just
got fired from your job it is going to
hurt it is going to be painful it’s not
pretty and nice I mean when is it ever
but if you can accept that and wrap your
head around it I promise you you’re
going to be so much better off and it’s
when I say that that I see people’s
faces start to soften and it’s kind of
this aha moment where they go okay well
yeah at least she was honest it’s gonna
hurt a little bit but it’s gonna be okay
two days later I’ll be home and then
I’ll get beyond it so studying realistic
expectations it’s the number one key and
overcoming this hurdle and complicated
pain management okay when you think
about realistic expectations whenever
you set them too high or they’re not
based in reality
they are often unmet did you know that
people say anyhow it’s pretty common
that unmet expectations are the number
one reason for divorce yeah I believe it
makes sense unmet expectations lead to
dissolution of the
they lead to people sniffing their tab
for a nice expensive dinner because it
didn’t meet their expectations of the
quality met expectations can kill your
sex life mmm by in my world unmet
expectations lead to poor patient
outcomes patients are just satisfied
they’re discouraged in their providers
and themselves and their recovery so if
we set those realistic expectations from
the beginning outline what’s gonna
happen and how real it’s going to be
it’s a night and day difference
so once we’ve set those expectations the
next step in the process is trying our
best to reconcile perception with
reality so we have this little scale
here we use this at any Hospital if
you’ve ever been in the hospital or the
doctor’s office and last 10 years you’ve
probably seen it so this is a skill we
use to let patients measure and then not
have pain they’re having now the scale
is pretty basic when you look at it okay
it’s simple
zero is no pain right 10 is the worst
pain possible attending right up there
by the little frowny face with the tears
coming down where’s maybe possible so
this does not mean the worst pain
compared to last like an hour ago when
we asked you or the pain compared to
yesterday when you first hurt yourself
or first sustained an injury this is the
worst paying possible that you could
ever experience or an indoor in your
entire lifetime so when we put it in
that perspective and explain it to
patients in a way they can understand
it’s another aha moment suddenly 10 out
of 10 seems a little silly right because
it’s a hangnail so it’s probably not the
worst pain that your and we’re going to
in your lifetime if it is good for you
because you live a really nice life
so when we marry in that perception with
reality our our outcomes are better when
you are able to perceive what is
happening to you and that sort of scale
and you can put it into context you
actually require less energy to overcome
what you’re going through
it becomes less traumatic less of the
fight less of a struggle when you can
perceive it and understand it and see
how it fits with the expectations that
you had going into whatever you’re
experiencing
here’s where it gets a little tricky the
expectations have been said our
perception is based in reality the next
step in the process is treatment okay
because everybody’s pain is subjective
that’s a really huge take away with this
everybody’s going to experience things
differently
your hangnail might be the worst thing
you’ve ever experienced right but this
guy’s broken ankle is way worse okay or
he thinks you’re hanging out was really
bad and his ankles not that bad so
everybody’s perception is going to be a
little bit different the problem with
our healthcare today is that pain is
subjective and treatment is not
treatment is objective if this then that
if your pain is a six here’s what you’re
going to get so that’s where people in
patients have to take ownership in what
they’re experiencing and going through
so that way their treatment is actually
appropriate for what they’re
experiencing so in my case a lot of the
treatment is medication related but it
also is things like massage or touch
therapy sometimes we do nutritional
coaching or weight loss coaching for
arthritis type pain distraction
techniques relaxation that sort of thing
but if you have been abreast of the news
and you know what’s going on in the
world today it’s pretty easy to think
about how the majority of people
associate pain with narcotic medication
I’m in pain I want it drugs that’s the
culture that we have grown into and I
want to explain why and how this came
about and what we’re doing and trying
so in 1991 something happened that
started us on this upward trend of
opioid use so this graph illustrates the
amount of opioid prescriptions that were
filled at commercial pharmacies between
1991 and 2013 anybody have any guesses
what happened in 1991 in the medical
community regarding pain that started
this upward trend
anybody know know yeah I’ve got somebody
in the back has an idea pain as the
fifth vital sign thank you that’s
correct so in 1991 the American Pain
Society came out and said in a response
to patients having pain in the hospital
than surgery we want to do something to
make sure that they’re getting really
great care so we are going to declare
that pain should be a vital sign if we
aren’t sure what vital signs are we’re
talking about things like heart rate
blood pressure the amount of
respirations you take per minute so
these are things that keep you alive so
when pain to the fifth vital sign is
introduced all of a sudden providers on
every single encounter are assessing
patients for pain and asking what is
your level of pain on a scale from zero
to ten so when you have a situation like
that and you have a patient population
if they’re lacking the education on
these expectations and their perception
of reality on this scale of 0
the 10 of course they’re gonna say yeah
I’m gonna ten out of ten
I want those really good drugs this
hangnail is killing me and I’ve been in
the ER for nine hours and I could use
some dilaudid so that’s how this process
started so without proper education
without patient awareness of the risks
and the side effects of these
medications the use of these opioid
prescriptions started to skyrocket
between 1991 and 2013 these
prescriptions a percentage rate of use
went up a hundred and seventy two
percent a hundred and seventy two
percent increase in the amount of opioid
prescriptions being filled at pharmacies
in this time frame so this is the battle
that we are now fighting what’s
happening is healthcare providers are
now trying to backpedal and go wait wait
wait wait wait wait maybe it wasn’t such
a good idea we need to assess pain maybe
not so rigidly but we need to look at it
another way so we’ve started to do non
pharmacological means of managing these
patients pain all these other things I
mentioned like sometimes nerve
stimulators for back pain and you sort
of light therapy for migraines anything
new and upcoming that’s not a narcotic
with these heavy side effects so the
medical community is spending millions
on research trying to figure out ways
that we can manage pain without causing
all of this high opioid use and that an
opioid epidemic and addiction that we’re
seeing now so I don’t know about you but
I find it strangely ironic that now
we’re trying to revert back to the pain
method that we used before all this
started and said
probably wasn’t such a good idea so
that’s a lot of what we’re doing in my
job anyhow to try and find alternatives
that get us out of this situation that
we’ve created and I don’t know you can
see this very well but I should probably
point out that that denominator is in
millions so that number in 2013 is 207
million prescriptions so our the problem
so what we have found in our program
have we kind of bring this all together
is that for this education piece through
helping patients understand these
expectations and set them from the
beginning and let them know what they’re
in store for and what’s coming ahead
when we do that help them understand the
scale and ground their perception in
some realm neighborhood of reality and
then find a treatment that’s
conservative as possible while still
managing their pain and keeping them
comfortable after surgery when we take
all those things combined we’ve
increased our satisfaction scores
meaning the amount of patients that say
they’re satisfied with their pain
management after surgery it was exactly
what they expected and they got what
they were looking for for their
providers by doing all of that we
increase the percentage of satisfaction
from 42 to 90 percent which is
incredible 90% of patients after surgery
saying yeah you know I knew what all
this ahead of time it’s exactly what I
was expecting so this knowledge not only
is great for the satisfaction of
patients
more important to me especially these
individuals are grateful they come to me
and they come to their providers and say
thank you thank you for giving us this
knowledge that helped bridge that gap
between the unknown and reality it took
away my fear and it took away my anxiety
so when we apply those principles across
the spectrum because as I’m talk about
paying in a hospital because that’s my
specialty like I said in the beginning
pain is not limited to the hospital
we’re talking about pain that you
experience every day divorce loss of a
loved one you know getting fired from a
job or losing a promotion that you’ve
been working so hard for for the last 10
years it’s all painful we all experience
pain on some different level but if we
set our expectations a reasonable level
we perceive what’s happening to us in a
realistic way I’m lucky enough to have
somebody there to kind of walk us
through it and we have better outcomes
pain is you know no different whoever
you’re talking to I mean I’ve been
willing to guess that the pain of a
broken arm probably using that much
different and then pain of a broken
heart okay
pain is unavoidable but it does not have
to control you and with my patients it
does not have to control their recovery
so that’s what I wanted to share with
you today thank you
you
you
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