One of the problems for people in recovery from drugs and alcohol is the need for pain management for surgical procedures and other painful conditions. If you believe as I do that the use of opiates will trigger the limbic system to spark addictive behavior, it is a serious matter to manage pain in recovery.

The answer is not whether to provide adequate pain relief. That is a given. There is no reason that anyone with addiction should be made to suffer needlessly. If we know that someone is going to suffer post-surgical pain or a similar level of pain for other reasons, the patient with addiction should be treated as one would treat anyone.

So, I advocate giving adequate analgesia using standard opiate pain medications. The post-operative course for the patient with addiction, however, should be completely different than for the non-addicted patient as I will outline.

When I was an intern on the Internal Medicine service at our hospital, if someone had severe diabetes, we had to have a meticulous flow sheet that showed what the patient’s glucose, electrolytes and other blood chemistries to keep a close eye on absolute numbers. This sheet was to be updated every two hours, and the trends were to be plotted, the fluids calculated and this was kept up for about 24 hours until the patient was stable.

In the case of addicted individuals who are being treated with opiates, a similar “intensive care approach” needs to be taken. The post-operative patient should be monitored for pain relief, cravings, anxiety and anything that would lead to immediate relapse if the patient was at home. The patient should be able to have supportive people with them. If he/she is involved in 12-step recovery, the sponsor should be involved.  Once past the immediate post-op period, the patient should be monitored and opiate pain relief given under supervision. Once the patient goes home, pain medications need to be monitored and controlled by an individual other than the patient or the patient’s family.

Many people with addiction are set up for relapse because this critical post-op period is not taken seriously as a major relapse triggering time. None of this is rocket science, but to send someone with addiction home with a bottle of pain pills without monitoring can be very dangerous for them. In my practice, it is not uncommon to hear of a patient relapsing after a surgical procedure. It gives people access to pain medications with a great excuse to use more medications than were prescribed or use the medications compulsively.

So, if you are a physician or nurse taking care of a post-op patient with addiction, please keep this in mind. If you are someone with addiction, please ask for the help that you need to do the right thing after surgery. If you are a family member of someone who has addiction, it is something worth discussing with your addicted relative or family member in a non-threatening way.

About the Author

Joseph Troncale, M.D. FASAM
Joseph Troncale, M.D. FASAM, has been working in addiction medicine for 20 years. He is the Medical Director of the Retreat.

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