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Doctors Try New Non-Narcotic Approach to Pain Management After Surgery

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Doctors are trying a new approach to pain management after surgery, in an attempt to reduce patients’ reliance on narcotic painkillers, according to The Wall Street Journal.

This “multimodal” approach includes cocktails of medications given to patients before, during and after surgery. The medication is delivered orally, intravenously and through injection into the tissues and nerves around the surgical site. By avoiding giving patients heavy doses of opioids, doctors hope to prevent the risk that patients will become addicted to painkillers. They also avoid the grogginess, nausea, hallucinations and constipation that can result from taking opioids.

Martin Clark Jr., an orthopedic surgeon at Sharon Hospital in Sharon, Connecticut, says when his patients rely entirely on narcotics, they are “drowsy and apathetic, they aren’t into physical therapy and they sit in bed.” In contrast, patients being treated with the new pain protocols are more able to stick with physical rehabilitation regimens to regain muscle strength and range of motion.

Patients undergoing knee replacement surgery at Canton-Potsdam Hospital in Potsdam, New York, receive medication before surgery including the anti-inflammatory Celebrex, and Lyrica, which treats nerve pain and blocks pain impulses to the central nervous system.

During surgery, patients receive anesthesia in the lower spine, as well as a sedative, intravenous Tylenol and an anti-nausea medication. The anesthesia lasts up to 24 hours after surgery. The surgeon also injects medications into the tissues around the knee, including a numbing agent, a drug to control bleeding and another anti-inflammatory agent. Once patients are in recovery, they receive a continuous cooling pad to decrease swelling and stimulate nerve endings, which reduces pain. They receive 24 hours of intravenous Tylenol and more Celebrex and Lyrica.

Patients are given oral narcotics such as oxycodone, but they generally don’t need them for more than two weeks, and often stop taking them after several days.

9 Responses to this article

  1. DQ / August 1, 2014 at 11:45 am

    I had surgery four months ago still in pain. Just had MRI saying I have tendinitis and degeneration in my meniscus. My doctor told me that he suspects I have an addiction issue and will no longer prescribe me pain medicine, I asked for alternative and he said to meditate and reduce anxiety. I go through more time with the pain than taking the pain killers so I won’t be addicted. I feel like my doctor is just fearing this crackdown on prescribing narcotic based meds. Also he recommended I take 800mg ibuprofen three times a day. I looked up online and it says anti inflammatory drugs don’t work on tendinitis. What can I do?

  2. Avatar of Terry
    Terry / April 15, 2014 at 9:17 pm

    I have to say, as a pain sufferer, I am “painfully” (pun intended) angry that doctors are now being paralyzed with fear of license suspension over the prescribing of pain medication. I had surgery in 1990 and had a good run. Unfortunately, the run is over. My MRI yielded new bulging disc with scarring and degenerative disc present. I had to threaten taking my family doctor to court and he prescribed Oxycodone and referred me, my suggestion as he was clearly out of his element, to a pain management doctor. Three shots for nerve root block, still pain, and all I get is generic Norco at its weakest strength. Our State Attorney General( AKA apparent drug czar) has made it his mission to ensure the government is now involved with doctor patient care. Didn’t matter he is a Republican who stated Obama Care would destroy doctor patient relations as he must have forgotten he sued to get it stopped for the very act of which he is committing. The government, at any level, should not be involved with what my doctor prescribes me. I have a medical history, a positive viewable MRI, all validating why I have chronic pain, and I cannot receive the proper pain relief. Generally one would expect this type of treatment in a third world country, or an oppressive government.

  3. Avatar of John
    John / January 7, 2014 at 10:10 pm

    Thank you, Drajjmd. I really wish you were my doctor because the NP I see at my clinic is all up in this Anti-Narcotic hysteria and it’s wreaking havoc on my chronic pain afflicted body. I had a doctor before who I’d seen for 13 years but transferred out of my clinic and she was managing my pain with low-dose morphine and Vicodin (I would only take the Vicodin in extreme cases); neither of these meds made me high or gave me a high–they just made my body feel normalized enough to do simple things. My old doc thought I had SLE, which fits with all of my history and symptoms, but this new “doc”/NP thinks that my stuff can be cured with physical therapy. -__- I have had these pains since I was a little kid, and I was active in my youth (played baseball, did bodybuilding at one point) but now the pain just took over. I really don’t know what to do anymore because this Anti-Narc NP is a real idiot.

    • Trish / August 6, 2014 at 12:20 am

      I agree that doctor’s are getting too paranoid with the narcotic medications. I did have an addiction to Vicodin at one time, but the weird thing about it is that it didn’t make me “high” but I was always happy, had more patience with my kids and it worked 3 times better than what my anti-depressant did. I spoke with my family dr about this and soon after, our doctor-patient relationship was terminated b/c they thought I was a drug addict and trying to get more Vicodin when all I did was ask a simple question. I asked my daughter’s psychiatrist about if she had heard of Vicodin being used as an anti-depressant and she told me that I would probably be surprised as to how many of her patients told her that Vicodin worked better for them than their anti-depressant. She told me that because the FDA has only approved it for use as a pain medicine that she couldn’t prescribe it as an anti-depressant. From what I know, most if not all of the anti-depressants are habit forming as well and if taken off of them, you have to eventually “wean” yourself off. So what difference does it make if you get addicted to an anti-depressant or an opioid? You would think that a doctor that is supposed to be concerned for you and that wants to help you, would take that into consideration. I was also told that there are a lot of people getting addicted to pain killers and doctor’s are cracking down on it, but then again, people are pushing to have marijuana legalized and is already in some states. REALLY?!? Makes no sense if you ask me.

  4. Drajjmd / October 29, 2013 at 5:17 pm

    I’ve found the opposite to be true in my patients particularly in patients receiving opioids for acute trauma/pain. It’s this hysteria that leads to the eventual under medication of pain. When necessary, and I believe ALL physicians will agree with me, there is really NO good and eaquivilant pain reliever as the opioids; not to mention that the NSAIDS as well as Tylenol pose their own risks( CV, GI, as well as internal bleeding). I understand the premise and it sounds good in theory but if we did a statistically significant trial, opioid pain management particularly in acute injury states would win hands down! Let’s stop the hysteria surrounding opioids and get patients with substance abuse problems the appropriate therapy rather than throwing out the baby with the bath water!

    • Trish / August 6, 2014 at 12:27 am

      Drajjmd, I wish too that you were my doctor. It’s nice to know that there are still doctor’s out there that will do what is necessary to help their patients with pain, even if it is a narcotic/opioid.

    • cella wilson / August 14, 2014 at 2:28 pm

      It’s too bad more doctors do not treat the patient instead of society phobias
      i have suffered and i do mean suffered with severe pain ( gets worse every year) from a almost fatal car accident
      pain is a constant for me in my life and has been for 20 years which also means i have NO quality of life
      if you only knew the number of times i was pushed to try suicide ( which i have failed at miserably)
      the only thing that will help my pain i fear is that option
      i have taken over the counter medications until my kidneys and liver were effected
      really is there such thing as quality of life that counts anymore?

  5. Avatar of William
    William / March 22, 2014 at 5:27 pm

    People with addictions need options. People with a family history of addiction need options too. That should be the first question a doctor or dentists asks. We lost our child due to an opioid based drug overdose. Not everyone becomes addicted but why not offer less dangerous options when they are just as effective. Save the heavy drugs for when it’s the only other option.

  6. Evonne / September 6, 2014 at 5:27 am

    So true William! I wish there were more options available out there in the non-narcotic pain management arena. Maybe soon…. Unfortunately everyone wants the magic pill that fixes everything, but we have learned that can come at a cost (addiction). Unfortunately, there were/are some unscrupulous doctors out there running some of these pain clinics that have given the states a reason to crack down on physicians. Unfortunately, there will always be people (doctors & patients) learning to skirt the system for a legal high…

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