Skip to main content

Advertisement

Log in

SCAMPs for Multimodal Post-Operative Analgesia: A Concept to Standardize and Individualize Care

  • Other Pain (N Vadivelu and A Kaye, Section Editors)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

We discuss the challenges and strategies in delivering post-operative pain relief that is both standardized and individualized as appropriate. Post-operative pain remains under-treated and is frequently complicated by side effects. Guidelines for multimodal analgesia report varying strengths of evidence. Additionally, there are particular evidence gaps in establishing how individual and population subgroups responses vary, due to pharmacogenetic, metabolic, and psychological variation.

Recent Findings

In cases where evidence is scarce or low quality, Standardized Clinical Assessment and Management Plans (SCAMPs) are an innovative method for healthcare practitioners to integrate available evidence resources and avoid unplanned variations in the quality of care delivered. Implementation of SCAMPs can be facilitated by the sheer volume of relevant information for drug prescribing and monitoring, drug-drug interactions, laboratory tests of organ function, drug metabolism and excretion data, electronic medical record data, and individual pharmacogenetic profile data.

Summary

Standardization of care using algorithms or computer-assisted prescribing is emerging as a useful tool to raise compliance where guidance does exist. Individualizing care may require computational analysis of vast quantities of individual and population data to support or lead clinician decision-making. Such technology is used widely across diverse fields ranging from meteorology and commerce to agriculture and gene sequencing, but there are particular applications and challenges within medicine. To maximize benefit and reduce harm from post-operative analgesia, standardization and individualization, such as SCAMPs must be balanced and employed as appropriate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97(2):534–40. Table of contents.

    Article  PubMed  Google Scholar 

  2. Apfel CC, Turan A, Souza K, Pergolizzi J, Hornuss C. Intravenous acetaminophen reduces postoperative nausea and vomiting: a systematic review and meta-analysis. Pain. 2013;154(5):677–89.

    Article  CAS  PubMed  Google Scholar 

  3. Alizadeh S, Mahmoudi GA, Solhi H, Sadeghi-Sedeh B, Behzadi R, Kazemifar AM. Post-operative analgesia in opioid dependent patients: comparison of intravenous morphine and sublingual buprenorphine. Addict Health. 2015;7(1-2):60–5.

    PubMed  PubMed Central  Google Scholar 

  4. • Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131–57. The panel identified a number of key research gaps, including the optimal methods for managing patients receiving opioids before surgery, the effectiveness of opioid-sparing multimodal regimens, and in a number of areas related to management of perioperative pain in infants and children.

  5. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ (Clinical research ed). 2008;336(7650):924–6.

    Article  Google Scholar 

  6. Gordon DB, de Leon-Casasola OA, Wu CL, Sluka KA, Brennan TJ, Chou R. Research gaps in practice guidelines for acute postoperative pain management in adults: findings from a review of the evidence for an American Pain Society clinical practice guideline. J Pain. 2016;17(2):158–66.

    Article  PubMed  Google Scholar 

  7. Caterson SA, Singh M, Orgill D, Ghazinouri R, Ciociolo G, Laskowski K, et al. Development of Standardized Clinical Assessment and Management Plans (SCAMPs) in plastic and reconstructive surgery. Plast Reconstr Surg Glob Open. 2015;3(9):e510.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Grace RF. Standardized clinical assessment and management plans (SCAMPs): perspectives on a new method to understand treatment decisions and outcomes in immune thrombocytopenia. Semin Hematol. 2013;50 Suppl 1:S31–8.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Casey Jr DE. Why don’t physicians (and patients) consistently follow clinical practice guidelines? JAMA Intern Med. 2013;173(17):1581–3.

    Article  PubMed  Google Scholar 

  10. Farias M, Ziniel S, Rathod RH, Friedman KG, Colan S, Newburger JW, et al. Provider attitudes toward Standardized Clinical Assessment and Management Plans (SCAMPs). Congenit Heart Dis. 2011;6(6):558–65.

    Article  PubMed  PubMed Central  Google Scholar 

  11. •• Farias M, Jenkins K, Lock J, Rathod R, Newburger J, Bates DW, et al. Standardized Clinical Assessment And Management Plans (SCAMPs) provide a better alternative to clinical practice guidelines. Health Aff (Millwood). 2013;32(5):911–20. Variability in medical practice in the USA leads to higher costs without achieving better patient outcomes. Clinical practice guidelines, which are intended to reduce variation and improve care, have several drawbacks that limit the extent of buy-in by clinicians. In contrast, Standardized Clinical Assessment and Management Plans (SCAMPs) offer a clinician-designed approach to promoting care standardization that accommodates patients’ individual differences, respects providers’ clinical acumen, and keeps pace with the rapid growth of medical knowledge.

  12. Rathod RH. SCAMPs: a new tool for an old problem. J Hosp Med. 2015;10(9):633–6.

    Article  PubMed  Google Scholar 

  13. Burgansky A, Montalto D, Siddiqui NA. The safe motherhood initiative: the development and implementation of standardized obstetric care bundles in New York. Semin Perinatol. 2016;40(2):124–31.

    Article  PubMed  Google Scholar 

  14. Lim F, Pajarillo EJ. Standardized handoff report form in clinical nursing education: an educational tool for patient safety and quality of care. Nurse Educ Today. 2016;37:3–7.

    Article  PubMed  Google Scholar 

  15. Marcos PJ, Huerta A, Enzler MJ. Using standardized care bundles in the emergency department to decrease mortality in patients presenting with community-acquired pneumonia (CAP) and acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Curr Infect Dis Rep. 2015;17(2):458.

    Article  PubMed  Google Scholar 

  16. Bettner W, Dorbad M, Gentle J, Hart B. Implementation of a standardized sign-out in the post-anesthesia care unit. Am J Med Qual. 2015;30(1):93.

    Article  PubMed  Google Scholar 

  17. Mattison ML, Catic A, Davis RB, Olveczky D, Moran J, Yang J, et al. A standardized, bundled approach to providing geriatric-focused acute care. J Am Geriatr Soc. 2014;62(5):936–42.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kinnunen UM, Saranto K, Ensio A, Iivanainen A, Dykes P. Developing the standardized wound care documentation model: a Delphi study to improve the quality of patient care documentation. J Wound Ostomy Continence Nurs. 2012;39(4):397–407. Discussion 8.

    Article  PubMed  Google Scholar 

  19. Wood DL, Brennan MD, Chaudhry R, Chihak AA, Feyereisn WL, Woychick NL, et al. Standardized care processes to improve quality and safety of patient care in a large academic practice: the Plummer Project of the Department of Medicine, Mayo Clinic. Health Serv Manage Res. 2008;21(4):276–80.

    Article  PubMed  Google Scholar 

  20. • Leotsakos A, Zheng H, Croteau R, Loeb JM, Sherman H, Hoffman C, et al. Standardization in patient safety: the WHO High 5s project. Int J Qual Health Care. 2014;26(2):109–16. Despite its success in other industries, process standardization in healthcare has been slow to gain traction or to demonstrate a positive impact on the safety of care. The High 5s Project is a global patient safety initiative of the World Health Organization (WHO) to facilitate the development, implementation, and evaluation of standard operating protocols (SOPs) within a global learning community to achieve measurable, significant, and sustainable reductions in challenging patient safety problem.

  21. Physician-Engaged Sourcing. Journal of Healthcare Contracting. February 2016.

  22. Stowers MD, Manuopangai L, Hill AG, Gray JR, Coleman B, Munro JT. Enhanced recovery after surgery in elective hip and knee arthroplasty reduces length of hospital stay. ANZ J Surg. 2016;86(6):475–9.

    Article  PubMed  Google Scholar 

  23. Xiong J, Szatmary P, Huang W, de la Iglesia-Garcia D, Nunes QM, Xia Q, et al. Enhanced recovery after surgery program in patients undergoing pancreaticoduodenectomy: a PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). 2016;95(18):e3497.

    Article  CAS  Google Scholar 

  24. Spanjersberg WR, van Sambeeck JD, Bremers A, Rosman C, van Laarhoven CJ. Systematic review and meta-analysis for laparoscopic versus open colon surgery with or without an ERAS programme. Surg Endosc. 2015;29(12):3443–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Chemali ME, Eslick GD. Meta-analysis: postoperative pain management in colorectal surgical patients and the effects on length of stay in an ERAS setting. Clin J Pain. 2016.

  26. Forsmo HM, Pfeffer F, Rasdal A, Ostgaard G, Mohn AC, Korner H, et al. Compliance with enhanced recovery after surgery criteria and preoperative and postoperative counselling reduces length of hospital stay in colorectal surgery: results of a randomized controlled trial. Colorectal Dis. 2016;18(6):603–11.

    Article  CAS  PubMed  Google Scholar 

  27. Watt DG, McSorley ST, Horgan PG, McMillan DC. Enhanced recovery after surgery: which components, if any, impact on the systemic inflammatory response following colorectal surgery?: a systematic review. Medicine (Baltimore). 2015;94(36):e1286.

    Article  CAS  Google Scholar 

  28. Wolk S, Distler M, Mussle B, Sothje S, Weitz J, Welsch T. Adherence to ERAS elements in major visceral surgery-an observational pilot study. Langenbeck’s Arch Surg. 2016;401(3):349–56.

    Article  Google Scholar 

  29. Wright J, Cullinger B, Bacarese-Hamilton I. Postoperative analgesia for enhanced recovery in joint replacement: audit of a new electronic prescribing order set. BMJ Qual Improv Rep. 2015;4(1).

  30. • Tracy TS, Chaudhry AS, Prasad B, Thummel KE, Schuetz EG, Zhong XB, et al. Interindividual variability in cytochrome P450-mediated drug metabolism. Drug Metab Dispos. 2016;44(3):343–51. Apart from changes in activity as a result of drug-drug interactions (by P450 induction or inhibition), the P450 enzymes can exhibit substantial interindividual variation in basal expression and/or activity, leading to differences in the rates of drug elimination and response. This interindividual variation can result from a myriad of factors, including genetic variation in the promoter or coding regions, variation in transcriptional regulators, alterations in microRNA that affect P450 expression, and ontogenic changes due to exposure to xenobiotics during the developmental and early post-natal periods. This article describes recent work evaluating the effect of some of these factors on interindividual variation in human P450-mediated metabolism and the potential utility of endogenous probe compounds to assess rates of drug metabolism among individuals.

  31. Stamer UM, Zhang L, Book M, Lehmann LE, Stuber F, Musshoff F. CYP2D6 genotype dependent oxycodone metabolism in postoperative patients. PLoS One. 2013;8(3):e60239.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999;91(3):693–700.

    Article  CAS  PubMed  Google Scholar 

  33. Angst MS, Lazzeroni LC, Phillips NG, Drover DR, Tingle M, Ray A, et al. Aversive and reinforcing opioid effects: a pharmacogenomic twin study. Anesthesiology. 2012;117(1):22–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Shipton EA. The transition from acute to chronic post surgical pain. Anaesth Intensive Care. 2011;39(5):824–36.

    CAS  PubMed  Google Scholar 

  35. Munafo MR, Stevenson J. Anxiety and surgical recovery. Reinterpreting the literature. J Psychosom Res. 2001;51(4):589–96.

    Article  CAS  PubMed  Google Scholar 

  36. Siripatrawan U, Linz JE, Harte BR. Detection of Escherichia coli in packaged alfalfa sprouts with an electronic nose and an artificial neural network. J Food Prot. 2006;69(8):1844–50.

    Article  CAS  PubMed  Google Scholar 

  37. Gradisar D, Grasic B, Boznar MZ, Mlakar P, Kocijan J. Improving of local ozone forecasting by integrated models. Environ Sci Pollut Res Int. 2016.

  38. Graves A, Liwicki M, Fernandez S, Bertolami R, Bunke H, Schmidhuber J. A novel connectionist system for unconstrained handwriting recognition. IEEE Trans Pattern Anal Mach Intell. 2009;31(5):855–68.

    Article  PubMed  Google Scholar 

  39. Aliper A, Plis S, Artemov A, Ulloa A, Mamoshina P, Zhavoronkov A. Deep learning applications for predicting pharmacological properties of drugs and drug repurposing using transcriptomic data. Mol Pharm. 2016;13(7):2524–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Zeng H, Edwards MD, Liu G, Gifford DK. Convolutional neural network architectures for predicting DNA-protein binding. Bioinformatics. 2016;32(12):i121–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. •• Tighe PJ, Harle CA, Hurley RW, Aytug H, Boezaart AP, Fillingim RB. Teaching a machine to feel postoperative pain: combining high-dimensional clinical data with machine learning algorithms to forecast acute postoperative pain. Pain Med. 2015;16(7):1386–401. Machine learning algorithms, when combined with complex and heterogeneous data from electronic medical record systems, can forecast acute post-operative pain outcomes with accuracies similar to methods that rely only on variables specifically collected for pain outcome prediction.

  42. Eccleston C, Fisher E, Craig L, Duggan GB, Rosser BA, Keogh E. Psychological therapies (internet-delivered) for the management of chronic pain in adults. Cochrane Database Syst Rev. 2014;2:CD010152.

    Google Scholar 

  43. Ebert DD, Zarski AC, Christensen H, Stikkelbroek Y, Cuijpers P, Berking M, et al. Internet and computer-based cognitive behavioral therapy for anxiety and depression in youth: a meta-analysis of randomized controlled outcome trials. PLoS One. 2015;10(3):e0119895.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Carr EC, Nicky Thomas V, Wilson-Barnet J. Patient experiences of anxiety, depression and acute pain after surgery: a longitudinal perspective. Int J Nurs Stud. 2005;42(5):521–30.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Richard D. Urman.

Ethics declarations

Conflict of Interest

Anair Beverly, Alan D. Kaye, and Richard D. Urman declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Other Pain

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Beverly, A., Kaye, A.D. & Urman, R.D. SCAMPs for Multimodal Post-Operative Analgesia: A Concept to Standardize and Individualize Care. Curr Pain Headache Rep 21, 5 (2017). https://doi.org/10.1007/s11916-017-0603-2

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11916-017-0603-2

Keywords

Navigation