Green, yellow, orange—how a stoplight is helping ortho patients manage pain

March 16, 2020 | by Edward-Elmhurst Health

When you’re in pain, it’s not easy to figure out how bad it is.

It’s even harder as a patient to determine what level of medication you need to ease the pain.

Orthopedic knee and hip replacement patients are often asked to describe their pain level on a scale of 1 to 10, then coordinate the appropriate strength of medication.

“People have a hard time trying to determine their level of pain,” says Karen Murphy, RN, BSN, MSC, Clinical Care Coordinator at Edward Hospital. “We’ve heard from patients that, when they go home, they’re not sure which medication to take.”

“Patients are under stress, and they’re seeing so many doctors and have so many medications, it’s hard to keep them straight,” says Andrew Kim, M.D., independent orthopedic surgeon on the medical staff of Edward Hospital.

Murphy, along with Tom Beris, M.D., independent anesthesiologist on the medical staff of Edward Hospital, and Tina Bobo, nurse administrator at Edward Hospital, came up with a multi-modal pain management plan that uses another way to gauge pain: a stoplight.

The stoplight approach has three levels of pain — green, yellow and orange — along with descriptions of the pain at each level. Clinical providers recommend a medication that goes with each level:

  • Green: No pain or mild pain • No pain • Hardly notice pain • Notice pain, but it does not interfere with activities • Pain sometimes distracts me • Pain distracts me, but can still do usual activities
  • Yellow: Moderate pain • Pain interrupts some activities • Pain is hard to ignore; avoid usual activities
  • Orange: Severe pain • Pain is focus of attention; it prevents doing daily activities • Pain is awful, hard to do anything • Can’t bear the pain; unable to do anything • Pain is as bad as it could be; nothing else matters

Murphy has been using the stoplight pain management approach in a study with some of Dr. Kim’s patients who were not taking opioid medication when they came in for surgery. The goal of the study is to see if the stoplight system will decrease opioid use for pain.

“We practice multi-modal pain management,” Dr. Kim says. “We use Tylenol — given in doses that are within the safety profile, it can be effective — along with other medications. We only use opioids such as Norco or oxycodone as rescue medication.”

For each color of the stop light, patients are instructed to use non-medication options first: distraction, movement and cold therapy.

  • Distraction: Simple activities such as reading, listening to music, or even talking and laughing with a friend or family member can help to distract you from mild pain. When you’re up to it, meditation and mindfulness, working on a craft or hobby, watching TV or using your computer can also help.
  • Movement: Repositioning your body and getting yourself moving are important stepping stones to your recovery. The more active you are, the more that movement can help to reduce your pain.
  • Cold therapy: Applying cold to your joints can also provide pain relief as well as reduce swelling.

Patients are advised to take narcotic (opiate) pain medication as needed, based on how much pain they’re experiencing.

“The goal is to see if we can decrease opiate use and use opioids appropriately. So patients can learn how to use them and when they should use them,” says Murphy.

Whether it’s spine surgery or a joint replacement, the expert physicians at the Edward-Elmhurst Health Orthopedic Center can help you get back to life as usual. Learn more.

Many individuals who become addicted to opioids were initially prescribed opioids to help manage their pain. Edward-Elmhurst Health is taking a lead in the fight against opioid addiction. Learn more about our opioid crisis initiatives.

If you or someone you love is struggling with an opioid addiction, Linden Oaks Behavioral Health can help you get your life back.

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