In the wake of the opioid epidemic, pain management has taken on an increasingly important role in medicine, as innovators work to find new, non-opioid ways to manage pain. That's especially true in ASCs where the number of elective orthopedic procedures is increasing and where surgeons are interested in better ways to help manage patients' pain.
In a Becker's ASC Review and Becker's Spine Review 19th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference workshop sponsored by Baudax Bio — maker of Anjeso — Nirav Amin, MD, orthopedic surgeon at Restore Orthopedics Spine and Surgery Center in Orange, Calif., discussed innovations in non-steroidal anti-inflammatory drugs (NSAIDs) and pain management with Anjeso delivered intravenously.
Four key takeaways were:
1. U.S. patients increasingly expect a speedy, pain-free recovery. "We have these algorithms that promote pain-free surgery, where you're going to get a total knee and run after two days," Dr. Amin said. "You have this unrealistic expectation of how well you can do after surgery when that's not a reality for 99 percent of us. Sure, there's always outliers who are doing well. But for the majority of us, we're going to struggle through the first four to six weeks after surgery."
2. Inadequately controlled pain has consequences beyond the patient's discomfort. While some discomfort may be inevitable, too much of it is a problem. Research has shown that pain that's not well-controlled leads to a host of other risks. Those include increased risk for post-operative complications like persistent pain or opioid use, hospital readmissions, delayed recovery, delayed mobility, delayed return to daily activity and more.
3. Anjeso is a non-steroidal anti-inflammatory that offers an alternative to high levels of opioids. In addition to showing improvement in pain in studies, ANJESO also appeared to improve function, an important measure of a pain drug's effectiveness. "If I walk from this podium to the end of the door, and I say my pain was four, and then I walk from here to down the hallway and I say my pain is four, but I had Anjeso, it shows my functional activity is that much better," Dr. Amin said. "So even if my pain profile is the exact same number, my functional ability is significantly better."
4. Anjeso is also cost-effective in the ASC environment. Anjeso, which received FDA approval in February 2020, has Medicare pass-through status for hospitals, meaning it is 100 percent reimbursed. For ASCs, it is 80 percent reimbursed. While some providers push back at the idea of losing that 20 percent, "Every little thing in the OR adds cost," Dr. Amin said. "So when you think about that, and you're getting 80 percent pass-through effect on CMS, you're comfortably covering your margins on that level."
Non-opioid alternatives have grown in the last several years amid continued concern over the use of opioids post-surgery. Anjeso is a new drug that offers a potentially viable alternative as a once-daily IV non-steroidal anti-inflammatory. The safety and effectiveness of this drug, along with its reimbursement status, makes it an option that is important for surgeons to be aware of and consider for surgeries in ASCs.