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Digital Issues

Archive >  January, 2014 XV, No. 1

Stop Overusing Opioids

You need to manage post-op pain, not eliminate it completely.

Ashish Sinha, MD, PhD

pain control LESS IS MORE Current pain control methods should aim at minimizing the overall use of opioids and focus on short-acting versions of the drugs when they're needed.

Your anesthesia providers or recovery room nurses likely have had conversations with patients that went something like this:

"I'm in agony. Give me the strongest pain meds you've got."

"But you might feel nauseous. You might throw up. You might be constipated."

"I don't care. Solve my pain now. Please."

It's understandable that patients in severe pain tend to focus solely on the source of their discomfort, which in turn causes anesthesia providers, surgeons and recovery room staffs to do all they can to lower pain scores to acceptable levels. Additionally, patients often accept any side effect associated with opioids as long as they're getting relief from the pain.

Patients who receive significant amounts of narcotics following surgery are at greater risk of suffering from constipation, nausea, vomiting and respiratory depression. If narcotics are associated with so many potential side effects, why are they used? They're used because they're highly effective for nearly immediate pain control.

What's the problem with opioids? Consider that they were created to control chronic end-of-life pain. They're powerful drugs originally intended to ensure a patient's last few weeks or days were as comfortably as possible. Gradually, opioid use became more widespread to treat everyday pain as well as the significant discomfort patients are in following surgery.

Many caregivers in the United States use narcotics to treat mild pain, more narcotics to treat moderate pain and even more narcotics to treat severe pain. That seemingly exaggerated approach to pain management is rooted in some truth, because a clear majority of the world's opioid consumption occurs in the U.S., which comprises only 5% of the world's population. In contrast, the World Health Organization recommends using oral or IV acetaminophen, NSAIDs and local anesthetics to control mild pain; all mild pain treatment options plus narcotics as needed to control moderate pain; and moderate pain treatment options plus narcotics as needed to manage severe pain.

The bottom line: Just because narcotics are effective doesn't mean they should be the only method you use to attack post-op pain. They should be a significant part of your plan for pain control, but not the basis for the entire approach.

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