Cedars-Sinai Expert: Try Non-Opioid Solutions to Pain Management
As the opioid epidemic continues to claim lives and shatter families across the nation, a Cedars-Sinai expert is urging physicians and patients to try managing pain without the addictive pills.
"Today, more than ever before, we have a host of other methods that can effectively lessen pain," said James Grant, MD, MBA, chair of the Department of Anesthesiology at Cedars-Sinai and physician executive in Perioperative Services. "Opioids should be prescribed sparingly because addiction is a real risk and there are safer alternatives that can be just as, if not more, effective."
The Centers for Disease Control and Prevention reports that overdose deaths involving prescription opioids were five times higher in 2017 than in 1999—claiming the lives of almost 218,000 Americans. Many of those addicted become dependent on prescription medications after a major injury or undergoing surgery.
The first step in lessening patient dependence on prescription medications after surgery or a traumatic injury is for physicians to make sure patients understand that managing pain doesn't mean they are going to be pain-free, Grant said.
"It's important for patients to understand that when you undergo surgery you won't be entirely pain-free,” said Grant. "We need to manage expectations and make sure patients understand there likely will be some discomfort associated with any procedure. But as days go by after the procedure, the discomfort should progressively subside a little until you get back to your pre-procedure state."
Grant's suggestions for non-opioid pain management include:
- Try Nonsteroidal, Anti-Inflammatory Drugs First—For many patients, over-the-counter medications like ibuprofen or acetaminophen can be just as effective in alleviating pain as opioids.
- When Possible, Utilize a Surgical Nerve Block—A peripheral nerve block is an injection of a numbing medication near specific nerves that can decrease pain in a particular part of your body during, and after, surgery. For some surgeries, an anesthesiologist may place a catheter, which is used to continuously bathe the nerves in numbing medication for two to three days after the surgery—alleviating the need for prescription opioids. Although a nerve block is not appropriate for every patient, Grant encourages patients to discuss their options with an anesthesiologist.
- Get Out of Bed—Countless studies have pointed to the importance of getting patients out of bed sooner postsurgery to alleviate pain and promote faster healing. In fact, one recent Cedars-Sinai study suggests that each step taken the day after surgery resulted in significantly lower odds of a prolonged hospital stay. The study, published in the February issue of JAMA Network Open, found that for every 100 steps taken, the patient decreased their length of stay by 4%.
- Rely on Support and Accountability From Caregivers—Caregivers, whether it be family, friends or others, are a vital component to postsurgical care and should be utilized to monitor and manage medication use, communicate with care teams and also help patients stay mentally and physically fit postsurgery.
- Turn to Alternatives Like Meditation, Reiki, Yoga and Exercise—The larger medical community is continuously exploring nonpharmaceutical options to elevate postsurgery pain. These alternatives include relaxation techniques like meditation, reiki and yoga, as well as exercised-based therapies customized for each patient and their condition. Some patients may find pain relief in other alternatives like essential oils, massage and physical therapy.
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