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25 Jun 2020

Managing pain after surgery: Looking beyond opioids

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June 25, 2020 Category: Health Posted by:


If you have upcoming surgery planned, one of your concerns may be post-surgical pain. With all the news coverage about the opioid crisis in the United States, you probably have questions about the best kind of pain relief for you. You may want to know how you can recover quickly, with as little discomfort as possible.

To understand the role of different kinds of pain relief, it helps to understand how your body responds to surgery, as well as the risks of certain types of drugs that may be prescribed to help reduce pain.

Immediate post-surgery needs

Right after surgery, you may benefit from the local anesthetic your doctor uses to relieve immediate pain at the surgery site. However, most local anesthetics, including liposomal bupivacaine, are not designed to provide pain relief beyond 12-24 hours post-surgery.

Post-surgical inflammation is a significant component of discomfort, and peaks between 24-72 hours after surgery, and inflammation may prevent longer-acting local anesthetics from working effectively.

Because of this, doctors frequently prescribe opioids to help patients cope with moderate to severe post-surgical pain after most types of local anesthetics wear off. A 2017 article published in Annals of Surgery reported that 90 percent of patients undergoing surgical procedures are prescribed opioids for pain management.

The problem with opioids

Opioids are powerful drugs that can help reduce pain, but they also bring with them serious risks, from adverse side effects to addiction.

Opioids you may have heard of include medications such as fentanyl, oxycodone, Demerol, Percocet and Vicodin, just to name a few. According to a 2013 article in Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, opioids can have the following side effects:

•   Nausea

•   Vomiting

•   Urinary retention

•   Constipation

•   Drowsiness

•   Itchiness

•   Slow and ineffective breathing

•   Low oxygen levels

Opioids are also far from ideal because of the risk of developing an addiction to them. You are at higher risk of addiction to opioids if you have a history of:

•   Abusing alcohol, prescription or recreational drugs

•   Using tobacco

•   Depression, anxiety or other mood disorders

•   Long-term pain

Or if you:

•   Take opioids longer than a few days

•   Take opioids more than prescribed

But the truth is, anyone can become addicted to opioids. And paradoxically, opioids can result in making you more sensitive to pain. One additional risk is the potential for other individuals to have access to leftover opioids after you are done taking most of your medication.

How can you avoid taking opioids?

First of all, talk to your doctor about your concerns before surgery. Make sure you are ready to ask about the options available to you and what is appropriate based on the procedure type.

Once your healthcare provider understands your concerns, you both can work together to develop a concrete plan to address any pain and discomfort – which is a normal response to most surgical procedures – in an appropriate way for your unique situation.

Non-opioid options for coping with post-surgical pain

Ask your healthcare provider to discuss potential alternatives to opioids for managing post-surgical pain ahead of your procedure. Be sure to mention all other medications you are taking, including supplements, plus any additional health concerns you have, as well as lifestyle issues.

Depending on your overall health, type of surgery and recovery plan, you may consider several strategies for your post-surgical pain management. Recent multimodal approach guidelines recommend asking your doctor about the following options:

•   Anti-inflammatory medications such as ibuprofen

•   Acetaminophen

•   Nerve blocks

•   Localized anesthetics

•   Non-pharmacologic options

Planning now will help you recover from your surgery better, with a reduced need for and potential elimination of opioids that could cause more health problems down the road. Knowing your coping strategies for post-surgery pain management ahead of time can help give you peace of mind and may lead to better recovery.

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