A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
Every physician takes the Hippocratic oath and promises to “do no harm.” In the face of the current opioid epidemic, this includes protecting our patients from dependence and addiction, including those who are suffering from debilitating acute and chronic pain. Sometimes this involves getting creative as we develop treatment plans. Luckily, opioids are not the only, nor always the best, defense against pain.
One patient who avoided the negative side effects of long-term opioid use was Beth Hunt. Beth was living life as a new mom when a horrible accident crushed her leg below the knee. She was flown to the nearest trauma center and immediately rushed into emergency surgery. She remained in intensive care for two weeks while she underwent multiple additional surgeries.
As you can imagine, Beth’s pain was excruciating. To manage the pain, she was given IV opioids 24 hours a day for the next three and a half months. During that 90-day period, Beth became somewhat dependent on the medication and even began anticipating the time for her next dose. This is a strong sign a patient is becoming physically dependent on the opioid. Concerned about the risks of long-term opioid use, Beth and her family came to me and we laid out a pain management plan.
The goal was to control her pain while substituting other mechanisms to slowly reduce her opioid dose. I used ultrasound and tiny catheters or tubes to direct medication to the major nerves in her leg that were the source of the pain. This therapy reduced her opioid use by 90 percent while her leg healed and she learned to walk again. Now Beth is opioid-free, has regained her quality of life and is spending time being active with her children.
It’s important to remember that while opioids can be helpful for short-term relief, they are not a long-term solution for managing pain like Beth’s because of their many side effects and the risk of dependence and addiction. Safe and effective pain management is of utmost importance, which is why there are many good reasons physicians may limit or avoid prescribing opioids in favor of safer, more effective alternatives.
For one, opioids are only effective for general pain, not for pain in a specific site like pain from a pinched nerve or slipped disc. Further, people who take them may build a tolerance, and need continuously higher doses to achieve the same relief. This establishes a major risk for dependence and addiction, particularly for smokers and others with risk factors for addiction. Beyond addiction, opioids present other negative side effects including sleepiness, constipation and respiratory depression. Even more serious, opioid-induced shallow breathing can be life-threatening, and along with a slowed heart rate, could be a sign of an overdose.
Beyond physician purview, our government has become involved in curbing the opioid crisis and legislators have enacted many rules and regulations to protect patients. For example, because studies show the longer people take opioids, the more likely they are to become dependent or addicted, some states have enacted prescribing limits on opioids. Additionally, prescription monitoring programs have been created in some states so physicians can see when a patient might be “doctor shopping,” or going from provider to provider to obtain opioid prescriptions.
While we work to reduce opioid consumption, we still have a responsibility to treat pain. Thankfully, there are many non-opioid options for managing pain. Targeted therapies such as injections or nerve blocks can help short-circuit pain from muscle spasms. Technological advancements have led to remedies that include spinal stimulation and radio wave therapy to treat pain that doesn’t reduce after treatments like physical therapy. Non-addictive medications such as antidepressants and antiseizure medications can treat certain types of pain, and many patients can find additional relief from alternative treatments such as physical therapy, acupuncture, meditation, and other relaxation techniques.
No matter what type of pain you experience, pain medicine specialists, like physician anesthesiologists, can help find a treatment plan that’s right for you. If Beth had continued to use opioids to manage her pain, she risked dependence or addiction and a myriad of other negative effects. With an alternative pain management plan, we avoided contributing to the opioid crisis that is in the forefront of the news today.
Image credit: Shutterstock.com