Managing pain with opioids: A doctor’s opinion

After nearly 20 years managing pain for my patients as an orthopedic surgeon, I recently found myself on the other side of the medical system. I was the patient in need of a major surgical procedure. It was an eye-opening experience to say the least, and I gained a new appreciation for how vulnerable a patient feels when it comes to pain management.

Opioids, such as Percocet and hydrocodone, are strong medications that play an important role in managing pain before and after surgery. Over the past 15 years, many factors have led to a dramatic increase in opiate prescriptions.

Orthopedic surgeons rank third after pain specialists and primary care doctors in the number of opioid prescriptions they issue. The increase in prescriptions has led to more patients who become dependent or addicted to these drugs.

This crisis has affected every social and economic class. Nearly one out of every three people in Maryland knows someone who is, or was, addicted. The rate of opioid-related deaths due to accidental overdose has more than doubled. These drugs cause more deaths than motor vehicle crashes or suicide. They’re also responsible for more patient deaths than cocaine and heroin overdose combined.

The United States uses more than 92 percent of the world’s opiates, and we consume 99 percent of the hydrocodone manufactured. Yet, studies haven’t shown any increase in patient-reported pain to warrant this use. We should address the societal acceptance for these medications.

Unfortunately, there’s not an easy solution to this problem. Doctors must do a better job of teaching patients about the risks of using opiates. Patients trust and rely on their doctors to guide them in managing their pain. Most patients do not willingly start abusing or misusing their pain medications. Many believe they are only following their doctor’s instructions.

Opioid alternatives

For most conditions that don’t involve surgery, doctors can manage patients’ pain without opiates. Medications like acetaminophen (Tylenol), certain anti-inflammatories (NSAIDs, like Motrin, Advil or Aleve), and Tramadol (Ultram) are all alternatives to opiate medications.

Doctors can help manage pain before and after surgery by carefully using opiates. However, more opiates don’t always lead to better pain control. In some cases, they can lead to opiate-induced hyperalgesia. This means the more opiate the body’s pain receptors see, the more they want. For chronic conditions, a pain specialist is the best person to help manage pain.

Role of patients and families

Patients and family members also play an important role in preventing misuse or abuse of opiates. It can be difficult to identify people at risk of addiction, but those with opioid dependency tend to have psychological distress and poor coping skills. Behaviors like losing prescriptions or getting early refills are clear indicators.

If a doctor expresses concern about possible addiction to a patient, the patient may be more open to their doctor’s concerns if family members also voice concern. At this point, it may be helpful to get the assistance of a pain management specialist or even going to a drug rehabilitation program.

During my recent surgery, I realized that if it was difficult for me to navigate the system of pain management, it must be terrifying for non-medical professionals. Fortunately, I came through with a great result and a new focus on making sure my patients are well informed about their pain management plan. While the opioid epidemic is a complex problem, it’s important for patients and doctors to have open conversations about pain management to help stop opioid addiction.


Alessandro Speciale, MD, is an orthopedic surgeon at The Spine Center at Anne Arundel Medical Center. To reach his practice, call 410-268-8862.

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