EXECUTIVE SUMMARY

In the new era of sparing opioids to help stem the opioid epidemic, surgery providers are talking with patients about pain management.

  • Help patients understand that pain treatment can make them feel more comfortable after surgery, but it will not eliminate pain entirely.
  • Surgeons also might refer patients to pain management professionals and psychologists to help them cope with their anxiety and concern about pain.
  • Discussions should center on the unpleasant side effects related to opioid use.

Through the harsh lens of a drug misuse epidemic that touches American lives from coast to coast, healthcare providers have learned that there is no such thing as a pain-free drug approach without terrible risk.

Surgeons and other providers are returning to non-prescription and opioid-sparing treatment approaches to help patients cope with pain. One such tactic is to talk with patients, discussing their pain relief expectations and helping them adjust those expectations as necessary.

“Surgery is not going to be a pain-free thing,” says Kirk A. Campbell, MD, assistant professor in the department of orthopedic surgery at NYU Langone Health. “You can be very comfortable, but you will not have zero pain. Pre-op counseling tells patients what to expect.”

For instance, Campbell does not provide pain prescription refills; he explains how patients typically do not take all their pain pills and how long a patient might need help from medication. He also can refer patients to pain management professionals if they need additional help coping with pain.

If a surgery patient is taking a narcotic medication already, then the patient is directed to meet with the pain management team before surgery. The patient is encouraged to decrease their narcotic consumption, Campbell adds. Other surgeons follow a similar path.

“During the preoperative visit, we have a detailed conversation with patients to discuss with them our pain management plan,” says David Liska, MD, a colorectal surgeon at the Cleveland Clinic. “It is important for patients to understand what to expect in terms of postsurgical pain and what we will do to help them through this.” If patients need additional help, a psychologist can meet with them to discuss coping mechanisms, Liska adds.

Healthcare providers can explain to surgery patients that opioid use can cause unpleasant side effects and actually slow down their recovery, says Roy I. Davidovitch, MD, Julia Koch associate professor of orthopedic surgery at the NYU School of Medicine and director of the outpatient joint replacement program and The New York Hip Institute at OrthoManhattan.

“We tell patients, ‘You can use opiate medication, but you need to understand you are buying certain side effects that are very uncomfortable,’” Davidovitch says. “There is dizziness, nausea, vomiting, sleep disturbance, and the sensation of being out of sorts.”

Opioid medication can prevent patients from getting out of bed and walking around as quickly as they might without the drugs. In observing patients after surgery, Davidovitch noticed patients often were not standing and moving or performing their physical therapy because of their opioid medication side effects of nausea, vomiting, and lightheadedness.

“Patients were walking around with IV poles and looked like zombies,” he recalls. “I decided to take them off opioids and see how they do. I immediately noticed that patients were more alert and getting out of bed. They weren’t asking for opiates as much as they were.”

Davidovitch’s change in how he viewed postsurgery pain management evolved as he watched his patients and noticed trends. “We need to be more mindful of medication side effects from opiates. This requires more investment on the education front,” he says. “As these opioid-sparing protocols become routine, there will be a generation of patients who have gone through it, and it’s something you won’t have to explain as much.”

After more than a decade of patients receiving large quantities of opioids to manage their pain, the new paradigm will take some time before it adopted universally. Davidovitch believes sparing opioids is better for patients. He says patients need to know how the new methods will help them feel better and improve faster after surgery.