Recuperative Pain Medicine (RPM) − Establishment of a RPM Service to Optimize Pain Management after Discontinuation of Epidural/IV PCA Therapy

Brian D. Philips, RN,MS,FNP
Assistant Director
Recuperative Pain Service 

Spencer Liu, M.D.
Clinical Professor of Anesthesiology
Director of Acute & Recuperative Pain Services

Barbara L. Wukovits R.N., BSN BC.
Director of Pain Services

Department of Anesthesia
Hospital for Special Surgery
New York, NY

Introduction - TOP

Many patients have difficulty with pain control after transition from patient-controlled analgesia modalities to oral analgesics.1  A recent study was conducted and aimed to evaluate how well pain was controlled, both at rest and during activity during epidural infusion and for 48 hours after the epidural catheter was discontinued.2  The results showed that pain scores increased after the epidural catheter was removed and remained elevated for at least 48 hours.2  The study concluded that “the reason(s) why pain scores increased after catheter removal in patients whose epidural infusion appeared to produce good pain control is unclear, but may reflect a problem with “hand-off” as patient care is transferred from the Acute Pain Service to the Surgical Service.”2 

The creation of the Recuperative Pain Medicine (RPM) service was intended to bridge the “hand-off” gap in pain management by adding a Nurse Practitioner driven pain service to help provide direct medical pain management to patients and also surgical service guidance in treating pain in the in-hospital, post-PCA period at the Hospital for Special Surgery.

The RPM service, implemented in August 2007, was established in response to multiple negative patient letters/comments received by the institution.  A recurrent theme in the letters/comments was that, following discontinuation of management by the acute pain service (APS) of patient-controlled analgesia (PCA) modalities, patients experienced inadequate pain management with oral analgesics and perceived that they were not being monitored by a pain management expert. 

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