The surgery went well. But now, a year later, the patient is still in trouble.
The problem is neither the surgery nor some mysterious postsurgical complication. It’s those pills in his pocket—the opioid painkillers first prescribed in the hospital. When he was discharged, he took home a renewable prescription…and still is taking the pills. He feels like he needs them. And he’s not alone. Medical or dental surgery often is the trigger for a long-term opioid dependency.
The truth is, it’s not primarily the post-op pain that leads to dependency—it’s the drugs themselves. And that’s a tragedy, because there is growing evidence that long-term use of opioids actually can increase the body’s sensitivity to pain.
But there is a way out—a growing movement within medicine to handle pain without opioids whenever possible. Without opioids, patients have fewer complications after surgery and recover faster—and they are able to go home sooner.
It’s still important to tackle pain, of course. Indeed, it’s critical. Acute postsurgical pain that isn’t managed effectively can trigger pain sensitivity throughout the nervous system, which can be difficult to reverse and can lead to a chronic pain condition.
To learn the best ways to manage pain after surgery without opioids, we interviewed integrative pain-management expert Jane C. Ballantyne, MD. Her recommendations…
What Your Doctor Can Do
If you’re planning to have an operation or dental procedure that typically results in the use of opioids, speak with your health-care provider to find out what nonopioid drug approaches are best for you. These include gabapentinoids, a class of drugs originally developed to treat seizures that has been shown to reduce postsurgical pain and opioid use. Caution: While gabapentinoids are considered nonaddictive, some people can develop a dependence on them.
If you are having surgery in your lower abdomen, pelvis, rectum or to a leg (such as knee replacement), regional anesthesia—nerve blocks—are a good option. They work quickly with fewer side effects than general anesthesia. They can be effective for post-operative pain, too—research finds that nerve blocks provide better pain relief than opioids.
What You Can Do Before An Operation
While there is plenty that your medical team can (and should) do, there is even more that you can do yourself to minimize postoperative pain so that you need less opioid pain relief—or even none at all.
Start by preparing your mind: When you need an operation, it’s easy to catastrophize—imagine all the bad things that can happen. That fearful, anxious response actually increases your risk for postoperative pain and complications and delays recovery. One approach that can help with pain management is cognitive behavioral therapy (CBT), which helps you learn how to reframe thoughts so that they are more realistic—which often means less negative—usually in just a few sessions. To find a CBT therapist, click on “Find a CBT therapist” on the website of the Association for Behavioral and Cognitive Therapies (ABCT.org).
Any of these self-help approaches also can help…
• Mindfulness-based stress reduction (MBSR), a form of meditation, is as effective as CBT at managing pain. Follow free guided meditation online from the UCLA Mindful Awareness Research Center (MARC.ucla.edu/mindful-meditations). Mindfulness-related apps also can help—including Headspace (Apple and Android, $9.99 a month, Headspace.com) and Simple Habit (Apple and Android, $11.99 a month, SimpleHabit.com).
• Guided imagery. Listening to an instructor who helps you imagine relaxing scenes has been shown to reduce postoperative pain. You can purchase audio for a “guided meditation for successful surgery” at HealthJourneys.com (starting at $11.98 for an MP3 download, $17.98 for a CD). Start listening in the days beforehand—and continue while you’re in the hospital.
Finally, make sure that you have your favorite music to listen to before and after your procedure. That, too, can ease pain.
Prepare your body, too…
Nutrition plays a big role in how well your body can recover from surgery. If you are obese and/or have diabetes, losing 5% of your body weight and improving blood sugar control can reduce your risk for post-op infection and pain.
Short-term fixes also make a difference. Many older patients, for example, don’t take in adequate protein, which can slow healing. And vitamin D levels below 30 ng/mL, endemic in the US, can increase the risk for infections as well as worsen pain. As soon as you are scheduled for surgery, ask your doctor to test your vitamin D levels and, if they’re low, to recommend supplementation.
Some dietary supplements also may help. The best studied is turmeric, which is anti-inflammatory and has painkilling properties. (Curcumin is a derivative, but the whole root—turmeric—has additional benefits.) There are several published studies by surgeons on turmeric, both pre- and post-op, that show that it eases pain in recovery and reduces the need for other painkillers. It does increase bleeding time a little, though, so discuss with your surgeon whether it’s appropriate for you.
After the Operation
Continue with whichever practices you started before the operation. In one study, young adults who used guided imagery after spinal-fusion surgery had less pain both in the next 24 hours and over the next two weeks, compared with those who didn’t practice it.
These additional nondrug approaches may reduce pain considerably…
• Electrostimulation. Devices that deliver very low levels of electrical stimulation can stimulate pain-related nerve fibers in a nonpainful way…and block painful stimuli from reaching the brain. Two readily available technologies include transcutaneous electric nerve stimulation (TENS) and pulsed electromagnetic fields. TENS machines are widely available in hospitals, and treatment usually can be obtained on request. Most insurance companies cover TENS for chronic pain, but you may need approval.
• Acupuncture also reduces postsurgical pain and the need for pain medications, especially if used within 48 hours after the operation. Unfortunately, few hospitals offer this option, so you’ll have to make your own arrangements—and it may not be covered by insurance.
Managing Your Pain Expectations
It’s important to discuss pain management with your medical team and to make sure that appropriate nonopioid methods are used if possible. After an operation, be assertive with the medical staff to make sure that your pain-relief needs are met. But it’s also important to realize that you likely will experience some pain—it’s unrealistic to expect no pain after surgery. Accepting that also is part of the process.