While opioid abuse occurs among chronic pain patients, should you worry about taking pain relief drugs after surgery? We look at who should not be concerned.
Doctors began prescribing painkillers widely because they observed that patients who received opioids after surgery rarely became addicted to them.
That’s still true, so don’t let the bad news about painkiller abuse around the country scare you into opting against a surgery that you would otherwise choose. You also don’t want to put yourself through excruciating pain unnecessarily. After a significant procedure, nearly everyone needs relief from pain in the first days or weeks — and eventually stops taking painkillers as the pain subsides.
What is an opioid?
The common opioid painkiller brand names include OxyContin, Percocet, Vicodin, Percodan, Tylox, and Demerol among others.
When doctors prescribe pain relief drugs for chronic pain problems, patients can get into trouble. In one study, about five percent of people became long-term users after they had six or more refills of an opioid within a year. But that study looked at out-patients with a variety of pain problems.
Among surgery patients, the numbers drop to two percent or less than one percent.
In a 2014 study, researchers found that three percent of patients who got their first opioid prescription after surgery were still using them three months later. In a new analysis, researchers at Toronto Western Hospital examined medical records for patients who underwent one of several surgeries from 2003 to 2010, including procedures on the heart, lung, colon, prostate, and uterus. All of the patients were age 66 or over and had been prescribed opioids.
As time went by, opioid use fell. After 180 days, two percent of the patients were still taking opioids. At the nine-month mark, the number had dropped to less than one percent, and it continued to drop. By the end of the year, just 168 of 37,650 surviving patients continued to take opioids. Although it’s possible that some of these patients may have been getting their painkillers illegally, or through other doctors, the main message is that addiction wasn’t a big risk in this group.
Should you worry about taking opioids?
You might be more concerned if recovery from the surgery you’re considering is likely to be especially painful. The numbers were highest for patients who received heart surgery, but still low: at six months, more than six percent were still taking opioids. Less than two percent of the heart patients were still taking an opioid at the end of the year.
Taking your pain meds isn’t just for your comfort. Let’s say you’ve had a heart procedure. Left untreated, pain can slow your recovery and increase your risk of complications like pneumonia and blood clots. You’ll need to begin walking and doing deep breathing exercises on a regular schedule. According to the Society of Thoracic Surgeons, it’s normal to lose your appetite for some time — even weeks — and have trouble falling asleep or find yourself waking up in the middle of the night. Taking a painkiller a half hour before bedtime helps. You may have mood swings or feel depressed. You may have pain in places you didn’t expect: in your shoulders or upper back between your shoulder blades. Those are all good reasons to take opioids as prescribed.
Some heart surgery patients have inflammation around the heart afterwards that causes chest pain and can be reduced by taking ordinary inflammation-reducers like ibuprofen and naproxen. But always check with your doctor, since these drugs can work against you after some procedures.
Pain will affect your mood, and anxiety and depression both tend to aggravate pain. To interrupt that bad feedback loop, do everything you can to boost your mood — watch comedies, listen to soothing music, and read up on subjects that fascinate you. If you’re in too much pain to distract yourself, you need more pain relief. Don’t worry that your doctor will think you’re an addict trying to take advantage of her. Instead, talk candidly about what your day is like, what you can or can’t do.
If pain persists, experiment with changing your diet. A high-sugar diet triggers inflammation, and so do high-glycemic foods that convert quickly to sugar in your body: white bread, white rice, potatoes, and alcohol. You don’t want to feel chronically deprived, but reducing pain is a great motivator, and you may find that you lose your taste for sweets or only want them occasionally.
July 20, 2017
Christopher Nystuen, MD, MBA