We thank the authors1,2 of these letters to the editor for their thoughtful reading of our editorial.3 The diversity of the opinions expressed in these responses reflects the diversity of issues enmeshed in the current crisis.
Chakrabortty and Gupta1 challenge readers to recognize that the complexities of opioid use are more than matched by the complexities of suffering. They suggest that efforts to contain over-prescription of opioids to treat pain may inadvertently result in pain and suffering that can, in turn, lead to suicidal ideations and worse. To use opioids compassionately with the goal of reducing suffering while not placing patients and community members at undue risk is a major challenge. We believe anesthesiologists can help patients during the highly stressful and painful intraoperative and immediate postoperative period by carefully using these powerful medicines. Although beyond the scope of the original editorial, we feel that informed and comprehensive care of the individual in pain will bring the best outcomes with the least risk.
Shishido and Bowdle2 amplify and extend some of the themes in our editorial, and we could not have said things any better than they did. To optimize opioid use guided by meaningful clinical endpoints and evidence is a far more patient-centric and medically justified approach to the treatment of pain than arbitrarily abandoning use of these analgesics. Special attention should be paid to their recommendation that patients be more engaged in the management of their pain and the safe use of the opioids they are prescribed to treat that pain. Preanesthesia clinics could be the place for patient education about postoperative pain, pharmacotherapy, and opioid stewardship and not just a place for preoperative screening and evaluations. Although some hospitals and surgery centers may be looking to shrink their preoperative clinics and replace in-person evaluations with phone calls or less for all but the sickest, we need to avoid missing both a need and an opportunity. Anesthesiologists should endeavor to both improve patient care and enhance their value to their patients and their institutions by meeting this important patient need.
Dr. Kharasch is the Editor-in-Chief of Anesthesiology, and his institution receives salary support from the American Society of Anesthesiologists (Schaumburg, Illinois) for this position. Dr. Avram is the Assistant Editor-in-Chief of Anesthesiology, and his institution receives salary support from the American Society of Anesthesiologists for this position. Dr. Avram also has a financial relationship with the Department of Anesthesiology, North Shore University Evanston Hospital (Evanston, Illinois) for research consultation. Dr. Clark is a consultant for Teikoku Pharma USA (San Jose, California).