FOR BREAKING NEWS VISIT WWW.QNS.COM JUNE 6, 2019 • HEALTH • THE QUEENS COURIER 41
8 important questions to ask your doctor about surgical pain management
If you or a loved one has an upcoming
surgery, pain management is probably
a top concern. Depending on the type
of surgery, doctors will recommend different
methods to manage your pain so
you can heal properly. It’s important to
understand what to expect, your options
for controlling pain as well as any risks
associated with them, particularly when it
comes to opioids.
An estimated 50 million surgeries are
performed each year and the majority
of these patients are prescribed opioids
to manage their pain, according to Dr.
Roy Soto, director of the anesthesiology
residency program for the Beaumont
Health System in Michigan. He says to
expect surgery to result in short-term
pain, but know that you can work with
your physician to manage this pain
while also minimizing the potential of
becoming dependent on opioid pain
“Historically physicians have treated
surgical pain with opioids due to their
ease of use and relatively cheap cost,” says
Dr. Soto. “Patients, however, can become
dependent on these medications very
quickly and become addicted, especially if
large quantities are given aft er surgery or
if prescriptions are refi lled.”
He explains that opioids are a class
of drugs that bind to receptors in the
brain, spinal cord and other parts of the
body. When that binding occurs and the
receptors are stimulated by the opioid
drug, pain is reduced, relaxation occurs,
breathing rate decreases and bowel activity
slows. While some of these eff ects can
be good (pain reduction), others can be
dangerous or even deadly (slowed breathing,
“Although patients become tolerant to
the pain-relieving eff ects of opioids, they
do not avoid the respiratory depressant
eff ects. Over time, patients will use more
and more drugs to control their pain, putting
themselves at greater and greater risk
of a serious respiratory compromise; that
is, they may stop breathing.”
Having left over opioid medication at
home can also be a concern for other
members of the family.
“Most patients having surgery in the
United States receive opioid prescriptions.
However, most of the prescribed pills
remain unused. Most of the unused pills
stay in the home in unsecure locations,”
says Dr. Soto. “Th is means that children,
teenagers, other adults, visitors or others
can readily access addictive and potentially
dangerous medications without a prescription.
A signifi cant portion of people
who are addicted to opioids report that
their fi rst exposure was to someone else’s
left over pills. Just to put this in context
there are roughly 1 billion unused opioid
pills left over every year.”
Dr. Soto suggests having a candid conversation
with your doctor about pain
management before surgery. Important
questions to ask include:
1) What type of pain will I have (burning,
throbbing, cramping, etc.)?
2) How severe will my pain be?
3) How long will the pain last?
4) When will the pain be at its worst?
5) At what point should I call you if I am
concerned about my pain?
6) What medications can I/should I take
for my pain?
7) Can I avoid using opioids? If so, what
non-opioid options are available to help
manage my pain caused by surgery?
8) What are the side eff ects of the pain
medications you will be giving me?
He also notes that there are many potential
advances in the health care fi eld under
development to help minimize or eliminate
the need for opioids.
One example is Heron Th erapeutics’
investigational agent HTX-011, a
long-acting, extended-release formulation
of the local anesthetic bupivacaine in a
fi xed-dose combination with the anti-infl
ammatory meloxicam. Heron is seeking
an indication for application into the surgical
site to reduce postoperative pain for
72 hours and the need for opioids.
In addition to these types of advances,
it’s important to consider other opioid
alternatives that can be part of a non-opioid
multimodal analgesic regimen.
“Th e simplest medications to use are
acetaminophen and non-steroidal anti-infl
ammatory drugs,” says Dr. Soto. “Both
have been safely used and sold over the
counter at your drug store, can be used
together, are inexpensive and have no
addiction potential. Other options include
medications that quiet nerve-related pain
(such as Gabapentin) and anti-depressants
that decrease long-term pain. Nonmedication
alternatives also work, and
you should ask your doctor about the utility
of relaxation, ice, physical therapy, acupuncture
and other holistic treatments,”
Dr. Soto says.
Above all else, he stresses it’s important
to realize that pain aft er surgery is normal.
“Many patients expect zero pain, and
many expect opioids and opioids alone to
treat any pain that might arise,” he says.
“Asking your surgeon appropriate questions
before surgery is an important way
of setting the right expectations so that
realistic goals can be set and achieved.”