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Drug overdose deaths broke records during 2020, and while the pandemic no doubt contributed, surgery plays an often-overlooked role in America’s ongoing opioid epidemic because many patients continue to use their prescribed opioids months after their procedures.
Pain medicine specialists are leading the way in addressing the opioid epidemic by developing strategies to reduce opioid misuse related to surgery, from helping to ease pain before the procedure to ensuring at-risk patients have access to naloxone to prevent an accidental overdose, according to the American Society of Anesthesiologists (ASA).
The Centers for Disease Control and Prevention reported the number of drug overdose deaths in 2020 soared to more than 94,000, nearly 30% more than in 2019. While the CDC notes synthetic opioids (primarily illicitly manufactured fentanyl) appear to be the main reason for the increase, persistent opioid use after surgery can play a role and physician anesthesiologists have been working to address the issue.
“Even if patients don’t take opioids before surgery, many continue to use them for months after surgery, increasing the risk for overdosing accidentally,” said David Dickerson, M.D., pain medicine specialist and chair of ASA’s Committee on Pain Medicine. “The bottom line is it’s never too early to involve a pain medicine specialist.”
Here are three ways physician anesthesiologists, who are experts in pain medicine, are innovating to help address the opioid crisis:
Prescribing prehabilitation
Just as rehabilitation after surgery helps patients regain function and improve quality of life, prehabilitation can ensure some patients are better prepared and healthier before surgery. During the preoperative assessment, the patient’s surgeon or physician anesthesiologist can prescribe patient-specific lifestyle changes such as exercising, reducing stress, improving diet and quitting smoking. Prehabilitation helps patients have better outcomes and sets them up for a successful recovery after the procedure, including regaining function and reducing reliance on opioids.
Managing pain before surgery
Many patients benefit from seeing a pain medicine specialist before surgery to treat pain unrelated to the reason for the surgery. This is especially helpful for patients who have chronic pain that lasts for three to six months or more. For example, a patient having a knee replacement may also be struggling with chronic back pain, increasing the risk that they’ll rely on opioids long after the surgery. Pain medicine specialists can assess pain and address it before the surgery through non-opioid alternatives (which also are being used to manage chronic pain). Some of the treatments include:
• Peripheral nerve stimulation – In this procedure, the pain medicine specialist implants a small wire under the skin near the source of the pain to disrupt pain signals to the spine and brain. It is often used to treat chronic back pain.
• Percutaneous interlaminar decompression – For this new treatment for spinal stenosis (narrowing of the space in the spine, a common source of back pain), the pain medicine specialist makes a small puncture in the lower back and inserts a needle to remove built-up tissue pushing on the nerves.
• Injections or nerve blocks – Injecting local anesthetics or other medications can help short-circuit the pain at its source, whether the patient is suffering from chronic back pain or headaches.
Ensuring access to overdose medication after surgery
Patients who are prescribed opioids after surgery may be at risk of an accidental overdose. If a patient is at increased risk (for example, the patient has breathing issues or consumes alcohol or other medications that impact breathing), the patient’s surgeon or physician anesthesiologist can prescribe naloxone to have on hand. Naloxone is a lifesaving medication that can be administered to rapidly reverse the effects of an opioid overdose. The ASA’s Opioid Resuscitation Guide provides an overview of the signs of an overdose.
It is important to prepare before surgery to reduce the risk of opioid overuse after the procedure. Learn more about the signs of opioid addiction, overdose and how to respond through resources from the ASA.
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