Medical Moment: Treating surgery-related pain without opioids

Published: Sep. 29, 2022 at 5:44 PM EDT
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(WNDU) - Every day, 130 million Americans die from an opioid overdose, sometimes with drugs that are bought illegally.

Sometimes, they come from a doctor. Oxycontin, Percocet, Vicodin. For years, they were a mainstay of pain management after surgery.

Now, more doctors are finding other ways to manage pain that doesn’t rely on opioids. Plastic surgeon Lauren Nigro said she and many of her colleagues recommend non-narcotic alternatives for patients, even for procedures requiring weeks of recovery time, like a tummy tuck.

“A lot of it has to do with the size of the cuts we’re making, and a lot of it has to do with also sewing those muscles together,” said Dr. Nigro, a surgeon at Mercy Medical Center.

But Dr. Nigro said there has been a movement to treat pain before, during, and after the procedure for the past several years. Before, patients are often prescribed Tylenol or other Acetaminophen for several days. During, doctors administer a long-acting nerve block that can last three or four days. After surgery, doctors sometimes prescribe non-opioid, Gabapentin, non-steroidal anti-inflammatories, and in some cases, an injection of Botox.

“There’s actually a substance in it that it inhibits, the substance P, which involves the pain pathway,” Nigro said.

Dr. Nigro said it’s important to use the pain management methods before and during surgery so patients are not suddenly in uncontrollable pain after, which leads to taking more than needed.

One new non-opioid way to relieve chronic pain is spinal cord stimulation (SCS). SCS is primarily meant for patients trying to avoid opioids when other chronic pain treatments such as physical therapy, surgery, or injections, do not work.

The SCS disrupts pain signals that travel between the brain and spinal cord and delivers the stimulation with a neurostimulator implanted under the skin.

Some types of pain the SCS treats are back pain, injuries to the spinal cord, post-surgical pain, and even pain after an amputation. With any surgery or new treatment, some side effects or complications can still happen, such as infection within the first two to eight weeks, bleeding, device migration, and in sporadic cases, spinal cord trauma.