(540) Creating Optimal Pain Management FOR Tailoring (COMFORT) guidelines for pain management: postpartum recommendations

Thursday, January 30, 2025

4:00 PM – 6:00 PM

Coauthor(s)

Alex Peahl, MD, MSc (she/her/hers)

Michigan Medicine
Ann Arbor, Michigan, United States

Submitting Author and Presenting Author(s)

Laura Peyton Ellis, MD (she/her/hers)

Resident Physician
UConn Health Obstetrics and Gynecology
Farmington, CT, United States

Coauthor(s)

Courtney Townsel, MD

Assistant Professor
University of Maryland Department of Obstetrics, Gynecology and Reproductive Sciences
Baltimore, Maryland, United States
Lisa Kane Low, CNM, PhD (she/her/hers)

University of Michigan
Ann Arbor, Michigan, United States
JW

Jennifer Waljee, MD

University of Michigan
Ann Arbor, Michigan, United States
MB

Mark Bicket, MD, PhD

University of Michigan
Ann Arbor, Michigan, United States
Dana Feldman, MD (she/her/hers)

Resident
Wake Forest University
Winston-Salem, NC, United States
Bryan L. Aaron, MD (he/him/his)

Medical Student
University of Michigan
Ann Arbor, Michigan, United States
Michelle Moniz, MD, MSc (she/her/hers)

Associate Professor
University of Michigan
Ann Arbor, Michigan, United States

Objective: To develop a new clinical practice guideline for postpartum pain management that promotes opioid stewardship, patient-centeredness, and health equity.

Study Design: We developed the COMFORT (Creating Optimal Pain Management FOR Tailoring pain management after surgery in pregnancy and childbirth) guideline using a rigorous, evidence-based, eDelphi process, the RAND-UCLA Appropriateness Method. After a systematic review, we identified 19 procedures, 6 populations, and 5 postpartum pain management strategies. Interprofessional panelists (n=17) and public members (n=3) rated the appropriateness of pain management strategies in 3 eDelphi rounds. Two consensus conferences were held between rounds with panelists and public members to resolve discrepancies and ensure public contributions. Quantitative ratings were assessed using basic statistics and the RAM definitions for consensus. Key findings from the panel discussion were summarized using a qualitative content analysis and matched to quantitative findings.

Results: Key panel recommendations for postpartum patients include: 1) provide robust patient education on postpartum pain management and opioid risk-reduction; 2) use scheduled non-opioid medications (e.g., acetaminophen, Non-steroidal Anti-Inflammatory Drugs); 3) utilize non-pharmacologic strategies as additive pain management; 4) utilize alternative inpatient strategies for individuals with complex pain; 5a) use judicious opioid prescribing as needed; 5b) utilize tailored prescription benchmarks to determine appropriate opioid prescription sizes for shared decision making (Table 1).

Conclusion: New guidelines for pain management after surgery in pregnancy and after childbirth may standardize care, reduce risks of opioid prescribing, and improve patient-centeredness and equity.