Strategies to manage surgical pain

Because addiction to pain pills often starts with an operation, surgeons are shifting to non-opioid approaches for pain control.

Many people who are struggling with opioid addiction didn't start taking the drugs at a party or at a friend's house. They were introduced to these painkilling medications by their doctor after a surgical procedure.

In the 1990s, the number of opioid prescriptions written for people undergoing surgery or experiencing pain conditions grew - and so did related problems. As a result, "we are in a current opioid epidemic, with 91 substance-related deaths each day, according to the CDC," says Dr. Elizabeth Matzkin, an orthopedic surgeon and assistant professor at Harvard Medical School.

You may be alert to these issues if you have a teenager or a young adult in your life. But they're not the only ones at risk. The Substance Abuse and Mental Health Services Administration estimates that the proportion of older adults who misuse opioids is set to double between 2004 and 2020, from 1.2% to 2.4%. In 2016, more than 500,000 Medicare Part D beneficiaries were given an opioid prescription by their doctor - and the average dose was well above recommended amounts.

Rethinking pain management

This growing problem has prompted a change in course for many surgeons. "Orthopedic surgeons are the third highest prescriber of opioid analgesics in the United States, and we are therefore in a pivotal position to change the current overprescribing patterns for postoperative pain management," says Dr. Matzkin. Today, surgeons like her are increasingly turning toward non-opioid medications and other options to manage pain. And they've also started having more conversations with patients before surgery to come up with safer treatment plans ahead of time.

If you're scheduled for a surgical procedure, having a plan to control pain after the surgery may help you avoid unnecessary use of opioids. Below are some tips to help you find better and safer ways to manage your pain.

Avoid opioid pain pills whenever possible. In many cases, non-opioid pain relievers, such as ibuprofen (Advil) and acetaminophen (Tylenol), will be effective in controlling postsurgical pain if taken as recommended. "We just completed a study of 163 knee arthroscopy patients who were sent home with non-opioid pain management," says Dr. Matzkin. Based on the findings of this study, 82% of patients who undergo arthroscopic partial meniscectomy (a common knee surgery) or chondroplasty (a procedure to repair cartilage in the knee) can achieve satisfactory pain control with non-opioid pain management.

Limit opioid medication use. If it is necessary to use an opioid, limit the amount of time you take it, says Dr. Christopher Chiodo, an instructor in orthopedic surgery at Harvard Medical School. Ideally, you should take it for less than a week - and only when other options won't work, he says. One way to reduce the amount of opioid medication you are taking is to alternate it with non-opioid treatments, such as ibuprofen or acetaminophen, if your doctor approves.

Adjust your expectations. "Orthopedic surgeons are also setting expectations for patients preoperatively. When people are having surgery, they should expect to have some pain or discomfort," says Dr. Matzkin. While no one should have to endure excruciating pain, having some pain is okay. "Letting people know that it's okay to have some pain can actually reduce the amount of pain medications required," says Dr. Chiodo. Sometimes when people aren't told to expect some discomfort or pain, they get nervous when they experience it, which leads to more medication use. Think of surgery like you would exercise: you'll be sore afterward, but you wouldn't (and shouldn't) take an opioid pain reliever to address the problem.

Use nonmedication strategies to manage pain. The key to effective pain management is to use a combination of methods. "If you are having surgery on a lower extremity, elevate it after the procedure. This can help substantially with pain relief, swelling, and wound healing," says Dr. Chiodo. Icing the area can also help in the first 24 to 48 hours after surgery. But be certain to follow your doctor's instructions carefully when using ice. It can cause tissue damage if used for too long - particularly in people who have reduced sensation in the area while the anesthetic used during surgery is wearing off.

Have a plan. Don't wait until after surgery to decide what type of pain management you will use. Discuss pain control with your surgeon before your operation, and agree on a course of action ahead of time.



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