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Opioid Safety After Surgery

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What My Patients Should Know About Opioids

It is not news to anyone in Tennessee that there is a real problem with opioid abuse. We are seeing an increase in patient concerns about whether these medications can be used safely. Most patients who are planning to have surgery will receive some type of opioid pain medication postoperatively. Although all opioids have a potential risk of abuse, I would contend that they can and should be used safely for post-operative pain relief. But let’s look at this a bit more closely.

The goal of using opioids after surgery

Opioids are narcotic pain medications which are derivative of opium, which explains the name. Their use, in my opinion, is for episodic pain relief, such as pain relief after surgery, or for pain associated with a terminal illness such as advanced cancer. They are not good drugs for chronic, everyday pain relief and that’s the cause of many of the problems we are seeing today.

The purpose of pain medication, of any sort, is to manage pain in a way to increase function. It is rare that pain can be completely eliminated, which is not the goal. General anesthesia will completely eliminate pain but it also eliminates function.  So, in administering pain medication, our goal is to help the patient get back to a normal level of function by reducing the pain to a tolerable level. Sometimes this requires opioids, sometimes other medications such as Ibuprofen or Naproxen, and sometimes it only requires movement or physical therapy.

Oxycontin vs Oxycodone

The drug Oxycontin has received the most attention due to its highly-addictive nature and it’s something I don’t prescribe for my patients. Oxycontin is a time-released form of the drug Oxycodone, which is an excellent drug for post-operative pain relief. Taken properly Oxycodone is nowhere nearly as addictive as Oxycontin, but it’s easy to understand the confusion.

An alternative to Oxycodone is its first cousin, Hydrocodone. Interestingly, though, Hydrocodone is one of the most easily-abused drugs due to its widespread availability.

Because of the abuse potential of Oxycontin, many patients have concerns about using Oxycodone. While there is always some degree of abuse potential with any opioid medication, they can still be used safely. I always prescribe opioid pain medication after surgery (unless you are in a pain management program).

Here are some things you can do to make sure that your medication is used safely:

• Only take pain medication that is prescribed for you. Don’t ever use someone else’s pain medication.
• Take the medication as it is needed, not on a set schedule. All pain medication is prescribed on an “as needed” basis, such as “take 1 or 2 pills every 4 hours as needed.” This means that you should not take any more than 1 or 2 every 4 hours. But if you don’t need it that often, then space it out. Don’t take it every 4 hours whether or not you need it.
• NSAIDs such as ibuprofen (Advil, Motrin) or Naproxen (Aleve) can be used to help with pain management. In fact, these can often be more affective for muscular pain than the opioids, but there is a slight chance to increase bleeding so you should check with your doctor first. (Toradol or ketorolac is an NSAID that I frequently prescribe for body procedures. Don’t use other NSAIDs while you are on this.) Tylenol, acetaminophen, can also be used to help with your pain.
• Ice can be incredibly helpful. This is a very under-appreciated and perhaps underused adjunct. Ice the area of surgery 20 minutes out of the hour. The ice packs that we have in the office are great for this.
• Just get up and move. It may be uncomfortable when you start out, but it will really help with your function and your pain. Movement has been shown to be of tremendous help in reducing pain, particularly with chronic pain.
• When you can, get off the pain medication. Many of us do not like the way opioid make us feel. So, when you can do without them, stop using them.
• Dispose of unused medication by placing them in the DisposeRx packet we give you. If these medications are not around, they can’t be used or abused.

When you are on any type of medication and you are not sure if you are using it properly, check with your doctor’s office. Used safely, opioids can be helpful in your recovery from surgery. Following these steps will help you with this.

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