The opioid epidemic continues to ravage the country, impacting virtually every American in some way. More than 80 percent of opioid addictions begin with prescriptions painkillers, and these medications continue to be the cornerstone of pain management following surgery. A recent JAMA study found that 6 percent of patients undergoing both minor and major surgical procedures continued to use opioids 90 days after surgery. Now that President Trump has officially declared the opioid crisis a public health emergency, we need to be considering, and adopting, alternative approaches for taking on the issue of effective post-surgical pain management.
[See: 8 Questions to Ask Your Pharmacist.]
There is very little information available to doctors that can help them navigate the subjective nature of pain management. More importantly, there are limited details on effective strategies that are being implemented within their practices. As a board-certified plastic surgeon, I make every effort to minimize exposure to opioids by discussing alternative options with my patients prior to surgery.
I recognize that the surgical setting can become an inadvertent gateway to opioid misuse and abuse, and I am committed to helping mitigate the crisis without compromising patient care. Recent research articulates two risks plastic surgeons should be cognizant of when addressing pain management: 1) the risk that a patient may become a persistent opioid user and 2) the potential for the non-medical use of prescribed opioids. Nearly 3 million individuals who had surgery in 2016 became persistent opioid users, continuing to take opioids three to six months after their procedure, according to recent research. Further, as a result of overprescribing, 3.3 billion pills were left unused by patients, making them available for potential diversion or misuse. Since less than 10 percent of people properly dispose of their unused medication, identifying effective non-opioid options can serve as an alternative.
[See: The 5 Latest Poison Control Threats Kids Face.]
I mostly deal with acute pain in my practice so, to avoid the use of opioids, I utilize a multimodal approach for pain management. This method doesn’t rely on one specific drug but rather a combination of two or more agents or techniques that work together to provide pain relief with fewer, and frequently no, opioids. As doctors, we want our patients to have little to no pain at all, and I believe this is achievable without the use of heavy drugs.
During surgery, I frequently use anti-inflammatories and acetaminophen, as well as a unique long-lasting analgesic, Exparel, which provides relief for 48 to 72 hours after surgery. This gets patients over the proverbial “hump,” when pain is typically the worst. Once a patient’s pain is adequately controlled, he or she can ambulate quicker, requiring less help from friends and family, and have a better recovery experience overall. In short, when you wake from surgery, your pain is already managed. By the time the drug is fully absorbed, you are well on your way to being able to handle any residual discomfort with the use of over-the-counter pain relievers. I’ve been using this option since it became available in 2012, and my office is now nearly opioid-free.
[See: 4 Opioid Drugs Parents Should Have on Their Radar.]
Using a multimodal approach has proven to be successful in my own practice. To truly fix this epidemic, there are multiple areas that need to be addressed, not just in the acute care setting. A multipronged, team-based approach that looks at chronic pain and addiction treatment, in addition to managing acute pain, can do just that. As surgeons, pain management specialists, anesthesiologists and addiction specialists, we need to work together to combat the opioid epidemic and find solutions. Like many things in life, there isn’t a one-size-fits-all solution, but increasing awareness about opioid alternatives, declaring this crisis a public health emergency and working as a team are certainly steps in the right direction.
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Taking a Team Approach to Acute Pain Management originally appeared on usnews.com
