A new survey conducted by Reader’s Digest and Choices Matter has revealed alarming attitudes and behaviors among seniors when it comes to opioids, the powerful and addictive drugs fueling a health crisis in America. According to the survey, about one-third of seniors who were prescribed opioids kept the unused pills at home, making them available for potential diversion or misuse. And while 70 percent of those surveyed believe opioids are often overprescribed, nearly 40 percent admit to using their leftover pills for conditions they weren’t originally prescribed to treat.
Unsurprisingly, research by Substance and Mental Health Services Administration has shown that those on Medicare are the fastest growing population with opioid use disorders. However, older Americans believe those ages 20-39 are most at-risk for opioid addiction or dependence, not their peers.
But there is hope. The Choices Matter survey suggested that seniors are open to alternatives to opioids that don’t involve avoiding needed medical care. Some 43 percent of those surveyed said they would choose a non-opioid option to manage pain after surgery and 82 percent agreed that patients and doctors need increased access to opioid alternatives. But, about a third of respondents acknowledged they don’t know enough about non-opioid options.
“This epidemic is a wildfire. And while it’s clear that efforts are being made to try and slow it down, it will take time before it’s extinguished. Educating healthcare professionals and patients about non-opioid options is an important step in the right direction,” said Dr. Shariff K. Bishai, an orthopedic surgeon and advocate for Choices Matter.
Talking to your doctor about non-opioid options can be intimidating and tricky—here’s what you need to know.
Monkey Business Images/Shutterstock
Don’t be afraid to ask your doctor
If you or a loved one are planning to have surgery, it’s critical to discuss all available pain management options with your doctor before the surgery takes place.
“Surgery has become an unintentional gateway to persistent opioid use, meaning many patients are still taking these medications three to six months after their surgical procedure,” said Dr. Alok Sharan, an orthopedic spine surgeon.
Yet, it’s important that your pain after surgery be controlled, as uncontrolled acute pain (pain that has a cause and will eventually subside) can turn into chronic pain (ongoing pain with a variety of causes that is more difficult to treat). Both doctors and patients have a role to play.
“It is imperative that healthcare practitioners be more cognizant of their prescribing habits and, along with patients, become educated on effective non-opioid pain management options for use before, during, and after surgery,” said Dr. Sharan.
Monkey Business Images/Shutterstock
To kick off the conversation about a pain management plan following a procedure, consider asking your doctor the following questions:
What kind of pain can I expect after surgery?
According to PlanAgainstPain.com, setting expectations of how a pain medication will work can impact its effectiveness. So, the first step of exploring your pain management options is to understand what kind of pain you might experience after surgery.
“It’s good to understand how much pain should be expected and what the plan is to manage pain,” said Dr. Emily Steinhagan, a colon and rectal surgeon. “For some surgeries, being pain free immediately is not the goal. Pain should be manageable enough to allow the patient to sleep or do other activities, but it’s important to understand what is typical after the specific surgery they are having.”
No two people experience pain in the same way, but it can be helpful to gain a better understanding of how much pain the majority of people who undergo a particular surgery experience.
“Everyone is different, but the surgeon should have a general idea of which surgeries are the more painful ones they do,” said Dr. Daniel Paull, an orthopedic surgeon.”
What kinds of medications are typically given for recovery after this surgery, and are opioids necessary?
Once you know what type of pain to expect, the next topic of discussion should be what kinds of medications are usually prescribed for this pain.
“Prior to performing a surgery, I make sure to discuss my pain management protocol and non-opioid options with each of my patients,” said Dr. Bishai. “These conversations empower patients to be active participants in their surgical experience from start to finish. Pain relief is not a one-size-fits-all approach and it should not be treated as such.”
According to the survey, nearly one in four seniors would avoid having surgery due to concerns about taking opioids to manage pain. However, there are effective non-opioid options available that can be used for a variety of procedures to minimize, or in some cases eliminate, the need for opioids following surgery.
Even if opioids are necessary, you may not need them for long.
If opioids are necessary for pain management after this surgery, how long will I need to take them?
Unfortunately, opioid prescriptions are often given with more pills than are needed and too little explanation on how they should be used, according to Brittany DiNatale, RN, BSN.
“It’s not like an antibiotic where it is essential or expected that a patient take the medication regularly and to its completion,” she said, adding that it’s important to understand exactly when and how much medication should be taken and that if it seems intimidating to have this conversation with the doctor that talking to nurses is always an option.
“If you are more comfortable you can go through questions or concerns you may have with your nurse,” said DiNatale. “These are critical conversations, especially when it comes to something as serious as opioids.”
It is also important to discuss safe disposal options with your doctor to get rid of any leftover opioid pills, so they are not left in the home and available for potential diversion. PlanAgainstPain.com shares tips on properly disposing unused medications in its post-op recovery tips.
Should my pain treatment be “multimodal”?
Your pain management plan should be “multimodal,” meaning that pain relief is best achieved using a variety of treatments. This allows your medical team to avoid unwanted side effects that may come with using large doses of a single medication.
“Many surgeons use multi-modality analgesia,” said Dr. Steinhagan. “The idea is that a combination of complimentary medications may be better than any one medicine alone. Some medications that may be used include acetaminophen, ibuprofen or NSAIDs, or medications such as gabapentin for neuropathic pain. In some situations, ice or heat may be helpful. For some surgeries, local or regional anesthesia can be given.”
There are a variety of options, including non-opioids, for inclusion in a multimodal approach to pain management, but communication with your doctor is vital to forming the best plan for your unique situation. The more your doctor knows about you, your individual pain tolerance level, and what your pain relief preferences are ahead of time, the better.
What non-opioid options are there for pain management?
Opioids aren’t the only way to deal with pain and your doctor should have detailed knowledge of what other pain management options are available for your particular procedure.
“Non-pharmacological therapies and techniques can also decrease pain and are often better than medications, particularly when it comes to chronic pain,” said Linda Robinson, MSN, BSN, R.N. For example, physical therapy, acupuncture, ice/heat applications, therapeutic massage, and other relaxation training are proven especially useful in treating chronic pain.”
Everyone experiences pain differently, therefore an individualized pain management strategy is needed. That’s why it’s important to ask about all your options.
Some non-opioid options include:
- Oral medications such as acetaminophen
- Anesthetics such as local and regional injections using lidocaine and bupivacaine (similar to the novocaine used by dentists during dental procedures)
- Long-acting local anesthetics such as liposomal bupivacaine
- Non-medication options such as electrical stimulation
- Complementary and alternative medications (CAM) such as acupuncture, meditation, relaxation techniques, massage therapy, spinal manipulation, tai chi, yoga, and dietary supplements
- Integrative treatment utilizing CAM and acetaminophen/anesthetics
What if I’m still prescribed an opioid to manage pain, despite expressing my concerns with my doctor?
Sometimes, an opioid may still be prescribed to manage your postsurgical pain. In these cases, it’s still important to ask about parameters that protect you from addiction.
Dr. Sinel suggests asking, “If an opioid is required, what is the lowest dose that I can take? What is the likelihood for dependence or addiction and how easy will this be to discontinue? Is there any concern if I don’t take opioids and try to tough it out?”
Sometimes postsurgical pain may not stem just from the surgery itself.
“Before reaching for a pill, you should talk to your doctor to see if physical activity would be helpful,” said Dr. Richardson. “Sometimes the post-operative pain felt after surgery is not actually from the surgery but from lying in bed all day. By getting up more frequently, walking around, and performing some light stretches (with guidance from your healthcare team), you may decrease your need for pain medication and accelerate your recovery.”
Patients have the ability to be informed about their pain management options now more than they ever have before. Pain management decisions should be considered and explored carefully, to ensure the right choice has been made for your unique situation. Visit PlanAgainstPain.com for resources and more information to help you make an informed decision. And make sure to ask your doctor the difficult but important questions that can help you receive the best pain management protocol for you.