If you or a loved one has an upcoming surgery, pain management is probably a top concern. Depending on the type of surgery, doctors will recommend different methods to manage your pain so you can heal properly. It’s important to understand what to expect, your options for controlling pain as well as any risks associated with them, particularly when it comes to opioids.
An estimated 50 million surgeries are performed each year and the majority of these patients are prescribed opioids to manage their pain, according to Dr. Roy Soto, director of the anesthesiology residency program for the Beaumont Health System in Michigan. He says to expect surgery to result in short-term pain, but know that you can work with your physician to manage this pain while also minimizing the potential of becoming dependent on opioid pain medications.
“Historically physicians have treated surgical pain with opioids due to their ease of use and relatively cheap cost,” says Dr. Soto. “Patients, however, can become dependent on these medications very quickly and become addicted, especially if large quantities are given after surgery or if prescriptions are refilled.”
He explains that opioids are a class of drugs that bind to receptors in the brain, spinal cord and other parts of the body. When that binding occurs and the receptors are stimulated by the opioid drug, pain is reduced, relaxation occurs, breathing rate decreases and bowel activity slows. While some of these effects can be good (pain reduction), others can be dangerous or even deadly (slowed breathing, for instance).
“Although patients become tolerant to the pain-relieving effects of opioids, they do not avoid the respiratory depressant effects. Over time, patients will use more and more drugs to control their pain, putting themselves at greater and greater risk of a serious respiratory compromise; that is, they may stop breathing.”
Having leftover opioid medication at home can also be a concern for other members of the family.
“Most patients having surgery in the United States receive opioid prescriptions. However, most of the prescribed pills remain unused. Most of the unused pills stay in the home in unsecure locations,” says Dr. Soto. “This means that children, teenagers, other adults, visitors or others can readily access addictive and potentially dangerous medications without a prescription. A significant portion of people who are addicted to opioids report that their first exposure was to someone else’s leftover pills. Just to put this in context there are roughly 1 billion unused opioid pills leftover every year.”
Dr. Soto suggests having a candid conversation with your doctor about pain management before surgery. Important questions to ask include:
1) What type of pain will I have (burning, throbbing, cramping, etc.)?
2) How severe will my pain be?
3) How long will the pain last?
4) When will the pain be at its worst?
5) At what point should I call you if I am concerned about my pain?
6) What medications can I/should I take for my pain?
7) Can I avoid using opioids? If so, what non-opioid options are available to help manage my pain caused by surgery?
8) What are the side effects of the pain medications you will be giving me?
He also notes that there are many potential advances in the health care field under development to help minimize or eliminate the need for opioids.
One example is Heron Therapeutics’ investigational agent HTX-011, a long-acting, extended-release formulation of the local anesthetic bupivacaine in a fixed-dose combination with the anti-inflammatory meloxicam. Heron is seeking an indication for application into the surgical site to reduce postoperative pain for 72 hours and the need for opioids.
In addition to these types of advances, it’s important to consider other opioid alternatives that can be part of a non-opioid multimodal analgesic regimen.
“The simplest medications to use are acetaminophen and non-steroidal anti-inflammatory drugs,” says Dr. Soto. “Both have been safely used and sold over the counter at your drug store, can be used together, are inexpensive and have no addiction potential. Other options include medications that quiet nerve-related pain (such as Gabapentin) and anti-depressants that decrease long-term pain. Non-medication alternatives also work, and you should ask your doctor about the utility of relaxation, ice, physical therapy, acupuncture and other holistic treatments,” Dr. Soto says.
Above all else, he stresses it’s important to realize that pain after surgery is normal.
“Many patients expect zero pain, and many expect opioids and opioids alone to treat any pain that might arise,” he says. “Asking your surgeon appropriate questions before surgery is an important way of setting the right expectations so that realistic goals can be set and achieved.”