Pain Management Without Opioids

Reading Time: 5 minutes After surgery, managing pain is important. According to recent studies, opioid prescriptions have quadrupled since 1999. Unfortunately, so have deaths related to opioid use. Over-prescribing pain killers is a frequent occurrence and can lead to misuse or diversion. Using opioids for 90 days or more post-operatively often leads to chronic use or use disorder. With these statistics in mind, surgeons are looking for ways to provide pain management after surgery without the use of opioids.

Benefits of reducing opioid use

A 10% reduction in opioid prescriptions given post-operatively could result in as many as 300,000 fewer people becoming chronic opioid users. Reduction in the use of opioids post-surgically can also reduce side effects which may slow recovery. These side effects often include constipation, nausea, dizziness, and over-sedation.

Anesthesia can be a gateway

An opioid-based anesthesia can be the introduction of opioids into a patient’s system. Opioids work somewhat differently than other medications by not just blocking pain receptors, but also shutting down endorphins, or feel-good, receptors in the brain while increasing the opioid receptors. This causes nerve cells to become more sensitive to pain. At the same time, the body is searching for opioids to bind with opioid receptors to produce a euphoric feeling. Opioid-based anesthesia can start this process. When patients are given opioids postoperatively, the addiction process may have already begun.

Minimally invasive surgery options

Another way in which opioid use can be avoided is with minimally invasive surgical (MIS) procedures. For example, minimally invasive fusion for spinal disorders has proven to be just as effective as open surgery. The benefits are significant and include less pain and opioid use, fewer complications, earlier mobility, and reduced recovery time.

ERAS protocol

One study utilized the enhanced recovery after surgery (ERAS) protocol in which a non-opioid anesthesia was used along with preoperative education, nerve blocks, and combinations of non-narcotic, pre-programmed analgesics. There was an 83% success rate in avoidance of narcotic pain medications post-operatively in the bowel resection patients participating in the study.

Risk factors

Certain patients may be more susceptible to an co-dependency on opioids. Additionally, some patients simply do not want to use this type of medication secondary to prior addictive history. All known risk factors should be considered. Women have a higher tendency for opioid use disorder than men. Among surgical patients, knee surgeries have an increased risk of using opioids longer post-operatively than those having other common procedures.

Opioid-free surgery is possible

Communication and planning are the keys to the avoidance of opioids. Patients should be prepared to discuss the anesthesia and post-operative pain control plan with the physician prior to surgery. Learning about the options available will allow patients to make informed decisions and possibly avoid the use of opioids with surgery.

0+
YEARS OF PRACTICE

Board Certified, Fellowship Trained Spine Surgeon

Dwight Tyndall, MD, FAAOS

Get a consultation with the premier spine surgeon for back and neck pain options.

Consultation