Opioid Addiction, Surgery and Pain

When Shirley’s doctor told her that she needed surgery, her thoughts made an immediate jump to one fear — as someone in recovery from opioid addiction, what would they give her for pain?

Shirley had taken opioids for over a decade after being prescribed oxycodone when she injured her back and eventually became dependent on them. After going through a treatment program and starting her life in recovery, she feared that if given opioids post-surgery, she’d fall back into addiction. So how does someone in recovery for opioid addiction receive pain management during and after surgery?

The Epidemic

Opioid abuse has been headline news across the country, especially after President Trump declared the epidemic of opioid addiction as a public health emergency. In 2016, approximately 60,000 people died following an opioid overdose in the United States.¹

Many of those with addiction first became dependent after using the drug for pain management with a doctor’s prescriptions. Others self-prescribed and accessed pills through friends, relatives or outside sources.

Highly-addictive opioids are prescribed because of their high efficiency in pain management. Pain can be detrimental to a patient’s mental and physical recovery after surgery. Even those without a history of drug usage or addiction should be aware of the potential risks when using opioids.

The concerns become amplified for people who have a family history of addiction or are in recovery. The problem is, it’s difficult to find clear solutions on what to do. First, it is essential that patients talk openly and honestly with their doctors about their addiction. Solution are impossible if the problem isn’t known.

No Easy Answers for Doctors

Creating a best-case treatment plan for patients with an opioid addiction and who also need surgery can be a challenging one. Doctors don’t have a defined protocol, and individuals require individualized care. Yet, even when aware of their patient’s addiction, some doctors may still decide it’s best to prescribe opioids for certain reasons:

• The necessity of surgery outweighs initial concerns about addiction.
• The physician’s duty calls to alleviate suffering during and after surgery, and opioids provide an immediate solution for certain types of pain.
• While in the hospital or a physical rehab center after surgery, a patient’s emotional and physical recovery is the goal. A patient experiencing pain is less likely to make the crucial steps to heal properly including walking, sleeping, physical therapy and even getting out of bed.
• Doctors may seek to curb immediate pain to prevent chronic pain. Once that takes hold, it prevents the nervous system from laying down new pathways, often permanently.²

Coming Soon, but Not Quite Yet

We are very close to having better options in pain management. Breakthroughs are being made in new drug options that target receptors in the brain and alleviate pain without triggering addiction. However, these studies are still in the preliminary stages meaning we are years out from seeing those drugs available to patients.¹ So in the meantime, what can we do?

Careful Planning

There are alternatives to opioids for pain management that are expanding and become integrated with various therapies. Some are quite surprising, and may at first cause skepticism, but the results are encouraging. They include:

• Immersive video games and virtual reality (VR) such as “SnowWorld” which was developed by Dr. Hunter Hoffman of the University of Washington School of Medicine in Seattle. Virtual reality can potentially reduce pain by 30 to 50 percent as it pulls the participant’s attention into the VR experience and away from the mental attention created by pain.
• Alternative medicine and practices, including meditation, hypnosis, breathing exercises, yoga, Tai Chi and similar martial arts that engage the internal being with physical movement, are being integrated into traditional therapeutic practices.
• Cognitive Behavioral Therapy (CBT) also has been shown to reduce pain. Research shows that pain has a strong psychological connection, and that a healthy mind can assist in pain management.
• Though controversial and still being researched, cannabis (also known as marijuana) can assist in pain relief without the potential of a lethal overdose like opioids.²

The outcomes for these approaches are difficult to predict and vary with individual patients. When a person faces surgery, experimenting with therapies is less than ideal. An addiction specialist can help navigate the options in a way that physicians often cannot.

Addiction Specialists

According to studies, nearly 2.5 million Americans are addicted to prescription opioids or heroin. That’s a lot of people who will need help when facing surgery. There are only 5,000 addiction specialists in the U.S. This means, it’s often up to individuals to seek out a specialist to get help.³

In the planning process before surgery, an addiction specialist can assist in mapping out the most effective course of action. Post-surgery recovery may include time in a sober living environment, a prescription for methadone which is a drug that helps in opioid recovery, or other treatments.³

With a specific plan based on the individual’s health needs and history, there is hope for a successful surgery and recovery that is free from addiction.

For additional help, call us at 1-800-533-5266.

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Sources

¹ Davis, Nicola. “Breakthrough brings non-addictive opioid alternatives a step closer.” The Guardian, January 4, 2018.

² Hellerman, Caleb. “Finding Alternatives to Opioids.” PBS.org, August 31, 2017.

³ Lemoult, Craig. “How Do Former Opioid Addicts Safely Get Pain Relief After Surgery?” NPR.org, April 20, 2017.