The Opioid Crisis and Surgical Pain Control: What You Need To Know
These days it is probably safe to say everyone has been impacted by the opioid crisis be it a friend, community member or even yourself. In 2017, Health and Human Services (HHS) declared opioid addiction a public health emergency of national importance, reporting 130 deaths related to opioid drug overdoses each day and over 11 million people misusing their prescription opioids throughout the year. 
As health care professionals who prescribe opioids (narcotics) to surgical patients, we recognize the important role we play in combatting this epidemic while still improving the lives of our patients through high quality surgical interventions.
Surgery: Improving Quality, Reducing Risk
Some degree of post-operative pain will most certainly accompany the majority of surgical procedures. Opioids, or prescription narcotics, are often indicated in the immediate post-operative phase to help patients tolerate post-operative pain and prevent complications associated with uncontrolled pain.
With any type of surgery, there are risks and benefits. Our responsibility is to work with each patient and through our quality standards to minimize surgical risks … and let me just say we do an exceptional job of it! The risk of a surgical site infection rarely prohibits or disqualifies a patient from undergoing surgery, because the risk is managed and minimized. We believe the same is true for the risk of opioid dependency.
By developing a multi-focused high quality, low risk pain management plan for our patients we are reducing the risk of dependency and opioid abuse. Here are a few of the strategies we have adopted through internal efforts and guidelines developed by the CDC and other external sources:
- Setting realistic expectations. Patient participation and education is key.At some point we created an expectation in health care that patients should expect to have zero pain, ushering in common phrases like "this better not hurt" or "I didn't think this was going to hurt." Perhaps it was the adoption of pain as a vital sign or creation of the patient pain scale measure but it's hard to say. Regardless of the cause, there is a common misconception that we have at our disposal sufficient and risk-free solutions to eliminate all pain associated with the physical traumas of surgery. Unfortunately, this just isn't the case and it is our responsibility to make sure our patients know what to truly expect. We work to educate patients about realistic expectations and goals for post- operative pain management before they go into surgery. Pain after surgery should not be severe or intolerable but it will also not be nonexistent. We make sure our patients understand the type and level of pain to expect, where they can expect to feel it and the best interventions to control specific types of pain.
- Listen to our patients. The patient plays a critical role in developing their pain management plan. We have patients from time to time who refuse narcotics for pain control and others who prefer as little pain as possible by all means necessary. Both of these options are a patient right and we work to create a realistic expectation for post-operative pain and a plan for administering alternative therapies taking into consideration patient risk factors for opioid dependency. At CSASC, our recovery room is deliberately staffed to ensure that our experienced nurses have the time to provide individual attention to each patient in the immediate post- operative period which allows us to implement a variety of timely and one on one pain control measures.
- Welcome a wide variety of alternative pain control therapies. Narcotics are ONLY ONE component of a good pain management plan. While a narcotic (opioid) pain pill is often a component of the immediate post-operative pain management plan, good pain management does not rely solely on narcotics. There are so many excellent non-narcotic options available to alleviate post-operative pain that we encourage! Of course they vary by procedure and patient, but some examples include non-narcotic pain medication like local anesthetics, Tylenol, Aleve and Motrin accompanied by ice, heat, massage, essential oils, sitz baths and distraction. Believe it or not, stool softeners can be an important component of any good pain management plan! We also want to get our patients up and moving after surgery because monitored activity can dramatically reduce post-operative aches and pains. Our facility actually won a national award last year for our work in non-narcotic post-operative pain control! Full Blog.
- Adhere to CDC guidelines for prescribing narcotics. Not too many, not too little...getting the prescription just right.Last year, the CDC released new guidelines recommending considerably fewer take home narcotics to be dispensed than most surgeons across many specialties were accustomed to and to be perfectly honest we were all worried that these new guidelines could be too restrictive. However, we must admit that following these guidelines has had very little impact on our patient's pain control plan and we are glad to be doing our part to reduce the amount of "left over" narcotics in circulation.
We recognize that we have a responsibility to our patients and our community to do our part in our ongoing commitment to always take care of the patient. At CSASC, we are proud to be doing just that!
For more information on preventing Opioid overdose by knowing the signs and symptoms, click here. Expired medications may cause more harm than you realize. To properly discard medications, click here.
