Wednesday’s Ask Dr. Walt — Take Great Pains to Avoid Opioid Addiction

Dear Dr. Walt,

I’m facing some low back surgery in the next few weeks. I’m concerned about becoming addicted to opioid pain medications after the surgery. But, I don’t want to suffer unnecessary pain. How can I manage my pain without worrying about becoming “hooked”?

— Anxious in Arkansas

Dear Apprehensive,

I want to commend you for your concern. A 2017 study of more than 36,000 surgery patients found up to six percent continued to fill prescriptions for pain medications (opioids) long after what would be considered normal surgical recovery.

Following surgery, many patients head home with prescriptions for 30 or more opioid painkillers—enough to trigger addiction No wonder the CDC says, “It only take a little to lose a lot.”

Pain expert, Dr. Jane Ballantyne, of the University of Washington says, “The truth is, it’s not primarily the post-op pain that leads to dependency—it’s the drugs themselves. And that’s a tragedy because there is growing evidence that long-term use of opioids actually can increase the body’s sensitivity to pain.”

So it makes sense that there is a growing movement among doctors to handle pain without opioids whenever possible.

The American Society of Anesthesiologists says, “The opioid crisis is huge and affects everyone, rich and poor, male and female, folks who live in urban areas as well as rural areas. It’s got to stop, and reducing opioid use during recovery after surgery is a big part of the solution.”

They add, “Nobody needs a prescription for 30 opioids, and even those who are in major pain and may benefit should only take them for a day or two. … There are effective alternatives and many people don’t need opioids at all or at least should drastically reduce the amount they take.”

To reduce reliance on painkillers, the anesthesiologists’ group offers this advice for coping with discomfort as you recover from surgery:

  • Only take opioids when in extreme pain. Medications such as ibuprofen (Motrin), naproxen (Aleve) and acetaminophen (Tylenol) can manage pain and soreness. These medications are not addictive and are far less risky than opioids.
  • Understand that soreness and discomfort after surgery are normal and will improve within a day or two. These sensations are different than pain, which is typically sharp or intense.
  • While in recovery after surgery, try to be clear when asked if you are in pain. Specify if you are sore, uncomfortable or in serious pain. 
  • If you have significant pain, ask that an opioid prescription be limited to a small amount, such as five pills. 
  • If you do take opioids, take them only for a day or two after surgery, three days at most. Your pain will improve significantly within a few days whether or not you take opioids.

© Copyright WLL, INC. 2019. This blog provides a wide variety of general health information only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment from your regular physician. If you are concerned about your health, take what you learn from this blog and meet with your personal doctor to discuss your concerns.
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4 thoughts on “Wednesday’s Ask Dr. Walt — Take Great Pains to Avoid Opioid Addiction

  • Disagree

    This is the possibly the most uninformed response I ever read. Pain patients do not become addicted to opioids, for the most part. That is hype that the media and the FDA wants you to believe. The so-called Opioid Crisis is caused by other factors, mostly illegal Fentanyl. Doctors are waging a war against pain patients– because of political mismanagement and greed. If you are significant pain, you ought to take something to control that pain– if they’ll give it to you. Tylenol and Ibuprophen (if you can even take it– I can’t), do NOTHING for significant pain, and they can be harmful drugs in themselves– if one takes too much. Take your pills; don’t worry about addiction. If you’re NOT taking them to get high but because you are in terrible pain, you have nothing to worry about (unless you are already addicted to heroin, or something like that). I am sitting here w/ terrible jaw pain; so far today, I’ve not taking anything but tylenol (it doesn’t work, unless you take it w/ something else). I can’t get to dentist until Friday, and the ER does zilch. The entire system is broken. I wouldn’t dare have major surgery, now– in this political climate. Doctors don’t understand pain– and frankly, no longer care. Pain used to be taken seriously. Also, the CDC is now re-evaluating the use of opioids, so let’s hope they finally “get it”. Pain patients just want relief. You shouldn’t have to suffer. I think I will unsubscribe from this blog.

  • Appreciate you taking the time to write and wish you the best in finding a pain specialist (physiatrist) who can help you get some relief.

    But, the truth of the matter is that there are no long-term studies showing that long-term opioids are safe or effective, and there are plenty of studies showing great harm and even death.

    In fact, the opioid crisis has so far been the most devastating public health crisis of the 21st century. In 2017 alone, more Americans died of drug overdoses than in the entire Vietnam War.

    CBS’ “60 Minutes” has a nice piece on this that you and other interested readers can view at https://www.cbsnews.com/news/the-opioid-epidemic-who-is-to-blame-60-minutes/.

    So, I stand by my comments.

    Dr. Walt

  • Dr. Patient Mark

    I agree with Dr. Walt. I have had surgery. It was minor, and I took some ibuprofen and acetaminophen and used an ice pack for a day or two, then warm compresses over the surgical site. The pain last for about 7-10 days, but it was very manageable. I did not take any opioids. After a month I was jogging and after 2 months I felt pretty much how I did before surgery.
    I am also a physician and have seen the tragic devastation that addiction to opioids can cause. I hope that you do get relief from your pain, but there are a lot of alternative to opioids that are less dangerous, as the blog post points out.

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