You don’t have to look hard for stories about the opioid epidemic and the number of people it has affected. According to the Centers for Disease Control and Prevention (CDC), nearly two million Americans abused or were dependent on prescription opioids in 2014. Patients and their families are more concerned than ever about the risks of opioids, such as oxycodone, for pain control after orthopedic surgery and the need to minimize them while managing post-surgical pain.
The Great Pendulum Swing in Opioid Prescription Habits
There are many reasons why the opioid epidemic exploded into such a huge problem, but most experts agree that the origin was a fear that providers were under-prescribing pain medication in the 1990s. My colleague, Dr. Seth Waldman, published a post explaining this phenomenon in more detail.
Several prominent organizations, including the Veteran’s Affairs (VA) healthcare system and the Joint Commission on Accreditation of Healthcare Organizations, pushed for policies based on that concern to aggressively assess and treat patients’ pain. Well-meaning physicians and organizations, as well as the public, aimed to completely rid patients of pain (and consequently improve their satisfaction with their healthcare), and started prescribing more powerful opioids for longer durations of treatment. The resulting upswing in prescriptions has led to the steep rise in serious consequences such as overdose, addiction, and death.
Now, all physicians in the surgical arena, and especially anesthesiologists, are trying to correct this trajectory. Postoperative pain management (sometimes referred to as acute pain management) is a delicate balance of combining multiple approaches to pain control, and one of the most important conversations a patient can have with his or her anesthesiologist and surgeon is to understand the normal type and duration of pain he or she will have after surgery and how to treat that pain appropriately. Pain-minimizing anesthesia techniques, non-opioid pain medications, rest, ice, and other treatment modalities, as well as open patient/provider communications some of the ways to truly get patients back in the game as quickly as possible.
Surgery Pain is Real and Needs to be Treated
One of the most important messages patients need to understand is that their pain is real and needs to be treated, but that it is short-lived and will go away. Opioids are often a part of treatment after surgery but their use should also be short-lived, just like their surgical pain. Orthopedic patients ultimately come in for an operation to restore their mobility, function, and comfort, and just as the type and timing of surgery are carefully selected so should powerful therapies like narcotics; they should be used to treat excruciating pain and to allow good rehabilitation.
Often, patients are afraid of being in a lot of pain and want to minimize it as much as possible, but avoiding pain entirely is not helpful either. The role of the anesthesiologist and acute pain management physician after surgery is to help patients determine how much pain they are in and how best to treat that pain.
The Role of Anesthesia & Analgesia in the Recovery Process
There are certain techniques that anesthesiologists can provide orthopedic patients – like regional anesthesia – that can stave off the need for opioids the early recovery period, immediately after surgery. Anesthesiologists may be able to add medications to nerve blocks that make the pain relief last as long as possible – all done during surgery while patients are asleep.
Following surgery, your anesthesiologist and surgeon may also be able to offer non-narcotic pain management options such as acetaminophen and non-steroids such as ibuprofen in tandem with other medications to reduce the overall amount of opioids a patient needs and the amount of time they need to be on them. Sometimes, anesthesiologists refer to this as ‘multi-modal analgesia’, and it’s a combination of medical therapies that we use to manage surgical pain the best way possible.
Anesthesiologists get questions about postoperative pain on a daily basis – and there has been a noted uptick in the frequency of conversations about the addictive nature of opioids. There are important issues to consider when discussing the very real consequences of opioid abuse while also educating patients on the vital role these medications play in the recovery process.
For the most part, opioids are prescribed in the days and weeks following surgery, and addiction is less of a concern during this short-term period. In some cases, opioids may be an essential tool in getting patients up and moving and back to their daily lives as they begin to heal and regain mobility. It’s a fine balance that requires constant communication and teamwork from your surgeon, your anesthesiologist, and the patient to measure, monitor and treat your postoperative pain.
Dr. Kanupriya Kumar is an assistant attending anesthesiologist at Hospital for Special Surgery.