Post-Surgical Opioid Pain Killers

Post-surgical opioid pain killers might not always be the best choice.

Posted Sep 30, 2013

Recently, two people I know had major surgeries; both had concerns about the amount of opioid medication they were given postoperatively and the reasons the medication was given.

The first is a young woman in her early twenties. She has an autoimmune disorder and on occasion endures a great deal of pain, though her pain is not usually treated with painkillers, but rather the “flare ups” of her condition are treated and the pain diminishes. She was in the hospital for a scheduled surgery to repair a damaged hip. After her surgery, she was given high doses of opioid pain medication for pain she said was a 9-10 on the pain scale.

However, no amount of pain medication reduced her pain, though the dose of medication she was given slowed her heart rate to dangerous levels. The woman’s mother insisted that a specialist in autoimmune disease be brought in, believing that her daughter was having a flare up. When the autoimmune problem was treated, the woman’s pain diminished to a level of 2-3 and could be treated with non-opioid medication. Surgeons had assumed, incorrectly, that the pain the patient felt was related to the surgery, not another underlying issue. It is unclear what the outcomes might have been for this patient if she had not had her mother serving as her advocate.

The second woman is forty and has been in recovery from addiction for more than fifteen years. She was scheduled for a gynecological-related surgery that would involve the removal of a large amount of tissue. Though she was uncomfortable using narcotic painkillers at all, she knew that given the scope of the surgery she was about to have, she would probably need these medications at least for the duration of her hospital stay, which was expected to be 24-48 hours, and likely for one to two weeks postoperatively.

In the hospital, she was given a narcotic drip that slowed her heart rate to such an extent that her heart monitor sounded an alarm every two minutes at no more than fifteen minute intervals throughout the night. She said to me of her hospital stay, “I didn’t know what to do. I was in a fog and though I felt the post-surgical pain intensely, I felt like the pain medication might be doing me more harm than good. It scared me to death to have my heart beat so slowly. I felt as if it might at any moment stop.” She continued with opioid pain medication for five days after her operation, but the side effects were worse for her than the pain, and she switched to high dose ibuprofen instead, which managed her pain adequately.

Recent reviews of medical data indicate that doctors are prescribing more painkillers, and while more than ten thousand people die each year from overdoses of prescription painkillers, pain treatment is not advancing. According to the website Medical Daily, “Looking at government data on the number of doctors’ office visits from 2000 to 2010, the researchers found no change throughout the 10-year span in the number of visits for pain that resulted in treatment with pain relievers. However, while treatment for pain with non-opioid painkillers, such as ibuprofen and acetaminophen (Tylenol) stayed about the same throughout—between 26 and 29 percent of all visits—the ratio of opioid prescriptions jumped from 11.3 percent in 2000 to 19.6 percent in 2010.

An analysis of doctors’ visits for new-onset musculoskeletal pain, which don't necessarily require opioid treatment, found that non-opioid prescriptions dropped from 38 percent to 29 percent of visits between 2000 and 2010, while opioid prescriptions rose.” This is a startling trend. Why are physicians relying so heavily on opioid prescription pain medications when the results seem to be not cessation of pain but thousands of avoidable deaths? Why aren’t other alternatives being tried first or in lieu of opioids?

I am not a physician, and therefore I cannot state equivocally that the two women I described above were overprescribed or inappropriately prescribed opioid painkillers. There is a time and a place for opioid painkillers to be used appropriately and effectively. But I can say as an addiction treatment professional that their experience as well as the data we have on rising death rates from opioid overdose coupled with increasing numbers of opioid prescriptions are concerning. Doctors have to spend more time with patients to understand the totality of their conditions in order to prescribe the right drugs in the right doses for the right period of time. Our lives depend on it.

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