Developing Strategies for Opioid Prescribing and Safe Pain Management

HSS Opioid Stewardship for Clinicians

The opioid crisis is one of the most pressing public health issues of our time. With overdose from prescribed opioids, heroin, and fentanyl a leading cause of accidental death in the United States, clinicians in all settings have urgently sought to avert the dangers of opioid overprescribing while safely managing pain.

At HSS, our surgeons, anesthesiologists, rheumatologists, physician assistants, nurse practitioners, pharmacists, and social workers have established a framework for assessing and treating opioid-naïve or -dependent patients, using prescription drug monitoring programs, and educating prescribers and patients on multimodal pain management.

Clinician Education & CME Credits

Visit HSS eAcademy for educational content on controlled substances, pain management, and chronic pain management.

“

Both pain and opioid-related side effects contribute to poor outcomes after surgery. On the other hand, multimodal analgesia can improve pain control, so it can directly affect the stress response. It also minimizes opioid requirements and opioid-related side effects to help facilitate recovery and better outcomes.

”

Ellen M. Soffin, MD, PhD
HSS Anesthesiologist

Research

As a multidisciplinary leader in musculoskeletal health, we are committed to sharing our expertise and collaborating with fellow clinicians as we all aim toward a new era of opioid stewardship.

20+

pain or opioid-related presentations at conferences in June 2022-2023

114+

active IRB pain management or
opioid studies as of June 2023

77+

pain management or opioid studies
published in 2022-2023

Featured Projects and Studies

Recently completed pilot study: Oral Ketamine for postoperative pain and opioid reduction

View our Publications

View our Publications

Tramadol prescribed at discharge is associated with lower odds of chronic opioid use after elective total joint arthroplasty. PMID: 35760515
Opioid sparing effects of intravenous and oral acetaminophen in hip fracture patients: A population-based study. PMID: 36758393
Buprenorphine for chronic pain treatment and elective orthopaedic surgery: a US national database analysis. PMID: 36566125
Patients Undergoing Primary, Cementless TKA had Similar Pain, Opioid Utilization, and Functional Outcomes Compared to Matched Patients With Cemented Fixation. PMID: 37142071
Preoperative cannabis use does not increase opioid utilization following primary total hip arthroplasty in a propensity matched analysis. PMID: 36129515
Patient perceptions of pain management and opioid use prior to hip arthroplasty. PMID:36683303

The Starr Foundation Grant

In 2019, HSS received a $3 million grant from the Starr Foundation to establish the C.V. Starr Endowed Chair in Pain Management. This grant has enhanced existing pain management studies and funded new studies, expediting the translation of research findings into practice, improving safe prescribing practices, and exploring alternatives to opioids.

Seth A. Waldman, MD, Chairman of the HSS Controlled Substances Committee and Advisor of Opioid Prescribing Practices at HSS, is the inaugural holder of the chair. The grant funds a full-time PhD researcher, Alexandra Sideris, PhD, who is dedicated to opioid and pain management topics.

Some highlights of work conducted with this grant include:

Inpatient and outpatient registries as pain and opioid informatics tools for research and QA/PI, as well as predictive analytics.
An opioid tapering tool incorporated into Epic for discharge prescriptions.
A survey study assessing opioid prescribing and tapering instructions.
Optimizations to further characterize high-risk patients for risk stratification.
HSS-wide documentation of opioid use/controlled substances from all surgical patients.

The Pain Prevention Research Center (PPRC)

Founded in 2023, The Pain Prevention Research Center (PPRC) at HSS is unique in its focus and commitment to studying the prevention of pain and associated deleterious outcomes. There are limited effective and safe treatments for chronic pain. Most treatments are only modestly effective for a subset of people, and efforts to develop novel pain treatments have been largely unsuccessful. Given the prevalence of chronic pain, as well as its significant personal and societal cost and immense complexity, the most promising approach may be in its prevention.

Goals of the Center:

Identify and apply innovative approaches to prevent acute and chronic pain.
Identify, conduct, and disseminate high-quality research on the prevention of acute and chronic pain and its adverse consequences.
Expedite the development of effective and safe therapies for those who suffer from chronic pain