In recent years, one of the most compelling discussions in the healthcare industry has been about the opioid crisis. Opioids, potent pain relievers often prescribed following surgeries, have been linked to many issues, such as addiction, overdoses, and even deaths. They can lead to many health complications and wreak havoc on patients’ mental and physical well-being.
What are Opioids?
Opioids are a class of drugs that include legal medications such as oxycodone, hydrocodone, morphine, and fentanyl, as well as the illegal drug heroin. They are derived from or are chemically like the compounds found in the opium poppy plant which heroin comes from.
Opioids bind to opioid receptors in the brain, spinal cord, and other body areas. They reduce the sending of pain messages to the brain and decrease feelings of pain. These drugs are generally safe when taken for a short time, and as prescribed by a doctor, but because they produce euphoria in addition to pain relief, they can be misused and lead to addiction. Misuse or overuse can result in overdose incidents and deaths, contributing to what is now known as the opioid crisis.
A Brief History of Opioid Use in Medicine
Opioids have been used for medicinal purposes, including pain relief, for thousands of years. But their use in modern Western medicine for surgery recovery began in the late 19th and early 20th centuries.
The development of morphine, derived from the opium poppy, in the early 19th century was a significant milestone. Morphine’s powerful pain-relieving properties made it an invaluable tool for managing surgical and postoperative pain. This practice became more prevalent with the invention of the hypodermic needle in the mid-19th century, allowing for more direct and effective drug administration.
In the following decades, other opioids like codeine, oxycodone, and hydrocodone were developed and used for pain relief and recovery after surgery. The use of these drugs expanded dramatically in the latter part of the 20th century. With this increased use came a greater understanding of the risks and adverse side effects of opioids, including dependency and addiction. This led to the current efforts to find alternative methods for managing post-surgical recovery.
Prevalence of Opioid Use in Medicine
In modern medicine, opioids are frequently used to manage postoperative pain, with recent research indicating that around 80% of surgical patients in the United States receive opioid medication for post-surgery pain relief. A study in JAMA Surgery found that one in sixteen patients prescribed opioids for the first time after surgery went on to have persistent, long-term use.
The Centers for Disease Control and Prevention (CDC) also note that the sale of prescription opioids nearly quadrupled from 1999 to 2014, during which patients’ reported pain remained consistent, reflecting a large increase in the reliance on these drugs.
Dangers of Opioid Use for Surgery Recovery
While opioids can be effective in managing pain after surgery, their use comes with several risks and potential complications:
- Addiction and Dependency: Opioids are highly addictive. Prolonged use can lead to physical dependence, where the body requires the drug to function normally. This can also lead to addiction, a chronic disease characterized by compulsive drug-seeking behavior despite harmful consequences.
- Overdose: Taking too much of an opioid or mixing it with other drugs (especially those affecting the central nervous system, such as alcohol or benzodiazepines, can lead to an overdose. Overdoses can cause life-threatening conditions like respiratory depression, where breathing slows or stops.
- Tolerance: Over time, patients can develop a tolerance to opioids, meaning they need larger doses to achieve the same level of pain relief. This can increase the risk of overdose and side effects.
- Side Effects: Common side effects of opioid use include drowsiness, mental fog, nausea, vomiting, constipation, and slowed breathing. These side effects can impact the patient’s quality of life and slow recovery.
- Masking of Symptoms: By suppressing pain, opioids can potentially mask symptoms of complications after surgery, leading to delays in recognizing and treating these issues.
- Withdrawal Symptoms: When the medication is stopped, patients can experience withdrawal symptoms such as restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, and cold flashes.
These risks have led many doctors to explore alternative, non-opioid methods for managing pain after surgery. These alternatives aim to provide adequate pain relief while minimizing the potential for addiction, overdose, and other adverse effects of opioids.
The Lingering Effect of Opioid Use
Despite opioids’ effectiveness in alleviating postoperative pain, their potential for misuse and addiction is a serious concern. Statistics show that as of 2019, nearly 10 million Americans misused prescription pain relievers in the past year, and more than 70% of the 70,000+ deaths from drug overdoses involved an opioid.
The widespread use of opioids for post-surgery pain management is closely linked to the more significant opioid crisis. This crisis emerged due to a considerable rise in the use of both prescription and non-prescription opioids since the late 1990s.
Prescription opioids are often provided for pain management after surgery, and while useful for short-term relief, extended use can lead to dependence and addiction. Approximately 21% to 29% of patients misuse opioids prescribed for chronic pain, and 8% to 12% may develop an opioid use disorder. Most individuals who use heroin are thought to have first misused prescription opioids.
The use of opioids in surgery recovery is directly connected to the ongoing opioid crisis, underlining the importance of exploring non-opioid alternatives for pain management and limiting the over-prescription of these drugs.
The goal of opioid-free surgery recovery is not merely about avoiding opioids but providing a comprehensive approach to pain management that addresses patients’ unique needs and improves their overall recovery experience. Some alternatives include:
- Non-opioid Medications: Non-opioid medications like aspirin, Motrin, Advil (ibuprofen), Aleve (naproxen sodium), and Tylenol (acetaminophen) are non-steroidal anti-inflammatory drugs (NSAIDs) that can effectively manage postoperative pain. Many of these medications act on different pain pathways, offering broad-spectrum pain relief.
- Multimodal Analgesia: The principle behind multimodal analgesia is to use several medications or techniques that work on different pain pathways. The aim is pain relief and reducing the side effects linked with individual drugs. A common regimen might include an NSAID like Tylenol (acetaminophen) and a local anesthetic, but the precise mix can be tailored to the patient’s specific needs and the nature of the surgery.
The Role of Mental Health in Surgery Recovery
Managing postoperative pain isn’t just a physical challenge but has significant psychological components. The discomfort and limitations following surgery can lead to feelings of frustration, anxiety, and even depression, which can, in turn, intensify the perception of pain.
- Understanding Pain: Recognizing that pain is a complex experience involving physical and emotional components can help individuals better manage their recovery process. Pain is subjective and can vary significantly from person to person.
- Mindfulness and Relaxation Techniques: Practices such as guided imagery, deep breathing, and progressive muscle relaxation can help divert attention away from pain, reducing its intensity.
- Cognitive Behavioral Therapy (CBT): This therapy can help individuals change negative thought patterns that may exacerbate pain. Through CBT, patients can learn to approach their pain more constructively, improving their ability to manage it.
- Social Support: A strong network of friends, family, or support groups can significantly impact an individual’s ability to cope with postoperative pain. Emotional support and understanding can provide comfort and reduce feelings of anxiety or depression linked with recovery.
By addressing the psychological aspects of postoperative pain, patients can gain more control over their recovery process, potentially reducing their reliance on pain medication and contributing to a more prosperous and holistic recovery.
Please contact Dr. Peter Howard with any questions or concerns about an upcoming or previous surgery. We can ease your post-op recovery process safely and successfully.