Additionally, the principles of the ALTO program have been adopted by the St. Joseph’s Departments of Family Medicine, Chronic Pain Management, PM&R, and Psychiatry. The multidisciplinary team works to tailor treatment plans for all patients. The ALTO program works closely with surrounding mental health facilities and detox centers such as Eva’s Village and the Straight & Narrow program. Peer screeners evaluate opioid-addicted patients in the emergency department in an effort to enroll them into a detox program immediately following their ED discharge.
Through education, implementation of novel concepts, and partnerships within the community, the ALTO program is changing the practice of pain management; the goal is to make the program a national model.
If you are interested in finding out more about the program or joining the newly formed ACEP Pain Management Section, please contact me or join the section.
Dr. LaPietra is the medical director of emergency medicine pain management at St. Joseph’s Regional Medical Center, Paterson, New Jersey, and chair of the ACEP Pain Management Section.
References
- Number and age-adjusted rates of drug-poisoning deaths involving opioid analgesics and heroin: United States, 2000–2014. Center for Disease Control and Prevention website. Accessed June 9, 2016.
- Opioid painkiller prescribing: where you live makes a difference. Centers for Disease Control and Prevention website. Accessed June 9, 2016.
Resources for Further Reading
- Balakrishnamoorthy R, Horgan I, Perez S, et al. Does a single dose of intravenous dexamethasone reduce symptoms in emergency department patients with low back pain and radiculopathy (SEBRA)? A double-blind randomized controlled trial. Emerg Med J. 2015;32(7):525-530.
- Blaivas M, Adhikari S, Lander L. A prospective comparison of procedural sedation and ultrasound-guided interscalene nerve block for shoulder reduction in the emergency department. Acad Emerg Med. 2011;18(9):922-927.
- Colman I, Friedman BW, Brown MD, et al. Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence. BMJ. 2008;336(7657):1359-1361.
- Frei R. Cleveland Clinic algorithm reduces migraine opioid use in ED. Pain Medicine News website. Accessed June 9, 2016.
- Friedman BW, Dym AA, Davitt M, et al. Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for treating acute low back pain: a randomized clinical trial. JAMA. 2015;314(15):1572-1580.
- Ghaderibarmi F, Tavakkoli N, Togha M. Intravenous valproate versus subcutaneous sumatriptan in acute migraine attack. Acta Med Iran. 2015;53(10):633-636.
- Ferrini R, Paice JA. How to initiate and monitor infusional lidocaine for severe and/or neuropathic pain. J Support Oncol. 2004;2(1):90-94.
- Galer BS, Gammaitoni AR, Oleka N, et al. Use of the lidocaine patch 5% in reducing intensity of various pain qualities reported by patients with low-back pain. Curr Med Res Opin. 2004;20 Suppl 2:S5-12.
- Gelfand AA, Goadsby PJ. A neurologist’s guide to acute migraine therapy in the emergency room. The Neurohospitalist. 2012;2(2):51-59.
- Herres J, Chudnofsky CR, Manur R, et al. The use of inhaled nitrous oxide for analgesia in adult ED patients: a pilot study. Am J Emerg Med. 2016;34(2):269-273.
- Kranke P, Jokinen J, Pace NL, et al. Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery. Cochrane Database Syst Rev. 2015;7:CD009642.
- Linde M, Mulleners WM, Chronicle EP, et al. Valproate (valproic acid or sodium valproate or a combination of the two) for the prophylaxis of episodic migraine in adults. Cochrane Database Syst Rev. 2013;6:CD010611.
- Moore RA, Derry S, Wiffen PJ, et al. Overview review: comparative efficacy of oral ibuprofen and paracetamol (acetaminophen) across acute and chronic pain conditions. Eur J Pain. 2015;19(9):1213-1223.
- Cohen V, Motov S, Rockoff B, et al. Development of an opioid reduction protocol in an emergency department. Am J Health Syst Pharm. 2015;72(23):2080-2086.
- Soleimanpour H, Hassanzadeh K, Vaezi H, et al. Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department. BMC Urol. 2012;12:13.
- Singh A, Alter HJ, Zaia B. Does the addition of dexamethasone to standard therapy for acute migraine headache decrease the incidence of recurrent headache for patients treated in the emergency department? A meta-analysis and systematic review of the literature. Acad Emerg Med. 2008;15(12):1223-1233
- Vigneault L, Turgeon AF, Côté D, et al. Perioperative intravenous lidocaine infusion for postoperative pain control: a meta-analysis of randomized controlled trials. Can J Anaesth. 2011;58(1):22-37.
No Responses to “St. Joseph’s Regional Medical Center Aims to Avoid Opioid Use in Emergency Department”