A Case Study of Patient-Driven Pain Management After Tonsillectomy/Partial Glossectomy

ABSTRACT


BACKGROUND: Current CDC Opioid Guidelines and State Laws make it difficult to manage patients suffering from acute post op pain. Adults undergoing tonsillectomy as part of the treatment for obstructive sleep apnea commonly suffer from suboptimal post op pain control, for up to 3 weeks, despite the use of narcotic medications. The simple act of swallowing their saliva and other fluids can be difficult because of the raw surgical site. Dehydration, malnourishment, dizziness, weakness, lethargy, narcotic dependency all poses significant risks postoperatively. It is not uncommon for patients to use up their narcotic prescription faster than as prescribe, thus running out of medication before the next refill is allowed by State Law.


OBJECTIVES: To investigate the effectiveness of the MindWise Protocol (MWP), a drug-free, patient-driven technique, to control pain after adult tonsillectomy.


DESIGN: A total of two, 20-minute office visits were provided pre-operatively the week prior to surgery. Patients underwent the MWP, which entailed:

1. Dispelling falsehoods regarding medical hypnosis and explaining how patients can use self-hypnosis to control pain after surgery.

2. A Rapid Hypnotic Induction.

3. A specific Post-Hypnotic Patter (script of direct and indirect suggestions) to establish hypno-analgesia.

4. Teaching self-hypnosis to establish post-operative Patient-Driven Pain Management.

5. Daily completion of a Pain Management Survey consisting of 6 questions to determine:

· Quality of sleep.

· Pain Level immediately before needing opioids.

· Amount of opioids taken to control pain.

· Pain level immediately before Self-Hypnosis.

· Pain level immediately after Self-Hypnosis.

· Time after Self-Hypnosis for pain to decrease.


RESULTS: Five adult (age 22 – 72 years) scheduled for surgery (4 tonsillectomy and 1 partial glossectomy), learned self-hypnosis through the MWP during two, 20-minute office visits. There were no side effects from self-hypnosis. Post operatively, patients were prescribed the surgeons routine pain management medications (Acetaminophen/Codeine 120-12mg/5ml SOL 10-15 ml, Q4hr and Viscous Lidocaine 1% gargle and spit, prn). On POD 2, four patients stated they no longer required pain medication because their pain level was 1 – 2, on a scale of 10. One tonsillectomy patient had not followed the surgeons or hypnotists post op instructions and had a pain level of 6. After counseling the patient, their pain level decreased to a 2. By POD 5 the patient no longer required opioids. All patients were seen in office POD 8; none required opioid refills. There were no complications.


CONCLUSIONS: The MWP provided a safe and highly effective adjuvant for post-operative pain control. Patients quickly became competent in Self-Hypnosis during the first office visit and learned to use the MWP as the primary method for pain management, as opposed to opioid prescriptions. The reader needs to be aware that all hypnosis techniques are NOT the same, just as all surgeries are not the same. Clinical applications and methods need to be taken into account. The MWP decreased commonly recognized opioid and post-operative risks. These cases support the MWP for improved postoperative pain control and suggest a need for further evaluation in other surgical procedures and specialties.

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