Bone and joint conditions, injuries and surgeries can be painful. Orthopaedic surgeons are committed to helping their patients recover and live as comfortably and pain free as possible, while also ensuring overall health and safety.
There are various ways to manage pain and discomfort. Patients and their doctors should work together to determine the most effective and safest course of action. Depending on the severity of the condition, pain management strategies can include:
- Exercise and activities that boost physical and mental health
- Cold and hot compresses
- Over-the-counter pain medications
- More powerful prescription opioids (also called narcotics)
When used as recommended, prescription painkillers can alleviate severe pain, especially during the hours and days immediately following an injury or major surgery. However, opioids are not a long-term pain solution and, when misused, can lead to addiction and even death.
The Opioid Epidemic
Numerous studies and alarming data have exposed the side effects, addictive dangers, and devastating consequences of opioid use and misuse. In fact, the United States is in the midst of an opioid epidemic, with millions of people dependent on or addicted to prescription painkillers such as codeine, morphine, oxymorphone, tramadol, hydrocodone, and oxycodone. A 2016 Washington Post/Kaiser Family Foundation survey found that 1 in 3 patients (34%) who recently took opioids for at least 2 months report being addicted or dependent.
According to the U.S. Department of Health and Human Services:
- Since 1999, the rate of overdose deaths involving opioids — including prescription pain relievers and heroin — has nearly quadrupled.
- Since 1999, 760,000 people have died from a drug overdose. Two out of 3 overdose deaths (66%) in 2018 involved an opioid.
- In 2019 (the most recent year data is available), 9.7 million people misused prescription pain relievers and more than 70,000 died from drug overdoses.
- On an average day in the U.S., more than 650,000 opioid prescriptions are dispensed, 3,900 people initiate nonmedical use of prescription opioids, and 78 people die from an opioid-related overdose.
In addition, patients already taking opioids prior to surgery have greater post-surgical pain, and face a higher risk of pneumonia, over-sedation, and even death.
Safely Manage Pain
Given the dangers of prescription opioids, how can patients safely and effectively manage pain?
- First, expect some pain. Pain is your body's early warning system and part of the normal healing process after surgery or an injury and will improve day-by-day. The first few days after a surgery or injury are typically the worst.
- Many injuries and conditions do not require prescription medication for pain relief.
- Splints, consistent use of ice or heat on and off the affected site, and non-opioid pain medications such NSAIDS (ibuprofen, naproxen, etc.) or acetaminophen are often enough to manage the pain and discomfort of many common injuries such as lacerations and fractures.
- Don't discount the powerful effects of a positive coping strategy, peace of mind and relaxation on your comfort and recovery. Studies have shown that patients who are prepared to experience pain after an injury or surgery are likelier to feel less pain and to feel more positive that their recovery is on track. The support of family and friends, as well as entertainment and laughter, can all help during times of discomfort.
- Discuss a pain relief plan with your doctor and stick to it.
- Your doctor can specify an appropriate plan to minimize pain, which may include a combination of opioids and over-the-counter pain medications. Because some pain medications may have adverse effects when combined with even over-the-counter medicines, it is important to tell your doctor about all medications you are taking.
- Your doctor also can discuss with you how much pain is too much, and how to know (in the rare instances) when a problem like an infection has occurred.
- If prescribed opioids, try to take as little as possible and stop taking them as soon as possible.
- One way to do this is by adding over-the-counter pain medications, such as acetaminophen (e.g., Tylenol) and ibuprofen (e.g., Advil) to opioid treatment. Before doing this, however, you should always check with your doctor. Many opioid pills already contain acetaminophen; in large doses, acetaminophen can cause serious side effects. In addition, people who are taking blood thinners should not take ibuprofen or any other nonsteroidal anti-inflammatory medications, such as naproxen (e.g., Aleve) or aspirin.
- If there is no acetaminophen in the opioid pills, you can add acetaminophen — either 2 extra strength pills every 6 hours around the clock or 2 regular-strength tablets every 4 hours around the clock for 2 days.
- Alternate the acetaminophen with ibuprofen so that you're taking one or the other every 3 hours, and never take more than 4 grams (4000 milligrams) of acetaminophen per 24 hour period.
- If you have had a nerve block (an anesthetic injection) that has worn off, you can take the stronger pain reliever every 3 hours for the next 3 doses.
- Take opioids only as prescribed.
- Never take more than instructed, take someone else's medicine, or give your medication to someone else.
- Never combine opioids with alcohol or anxiety medication.
- Never use opioids to treat anxiety or to sleep, out of fear of pain, or to feel good.
- Always store and dispose of opioids safely.
- Pain relievers are a leading cause of serious poisoning of children and pets when medications are left unsecured.
- Hide or lock up opioid medications to avoid access by family, friends, or houseguests.
- Keep prescription medications in their original packaging so it is clear for whom the medications were prescribed and the directions for appropriate use.
- Place unused opioids in a disposal unit in a hospital, pharmacy, or police station. To find a disposal site near you, visit the U.S. Drug Enforcement Administration's Controlled Substance Public Disposal Locations.
- Remember: Only one doctor should prescribe opioids for a patient at any given time. Visiting multiple doctors to get multiple prescriptions for controlled substances like opioids is known as "doctor shopping." As medical record systems and state databases are implemented and improved, fewer patients will be able to secure pain prescriptions from multiple providers. And many states have already enacted laws along those lines.
While minimizing patient discomfort remains an important goal of orthopaedic care, great caution should be used in prescribing and taking opioids. Orthopaedic surgeons, and all physicians and health care professionals, are working together to change the culture of pain management, with the ultimate goal of significantly reducing opioid use and misuse.
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AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.