Alternatives to Opioids: Dealing With Post-Amputation Surgery Pain
Over the past 40 years, there has been a significant shift in patients’ attitudes towards pain management. Back then, patients would refuse pain medication, like the prescription opioid codeine, due to concerns about addiction. But in the 1990s, with the increasing availability and heavy marketing of prescription opioids, pain became something that patients wanted to control at all costs.
However, with drug overdose deaths from prescription opioids rising to over 17,000 in 2017, some surgeons are now trying to change patients' expectations about managing pain after surgery. Instead of aiming to eliminate pain completely, the goal is to make it tolerable.
To test patients’ post-surgery pain tolerance after educating them about the risks of opioids, researchers at the University of Michigan conducted a study on patients undergoing surgical procedures. The study found that when patients were informed about non-opioid pain relief options, more than half chose not to use prescription opioids after their procedures. Moreover, almost all patients reported that their pain was manageable without using opioids.
The study included 190 participants who underwent various surgical procedures, such as gallbladder removal and hernia repair. Patients were counseled about managing their pain without opioids and were given alternating doses of acetaminophen and ibuprofen for non-opioid pain control. They were also provided with a small prescription for opioids as a backup option.
When patients were informed about non-opioid pain relief options, more than half chose not to use prescription opioids. Moreover, almost all patients reported that their pain was manageable without using opioids.
The study's results emphasize the potential for reducing the overprescribing of opioids by surgeons. From 2010 to 2016, new opioid prescriptions by surgeons increased by more than 18 percent. Overprescribing not only increases the risk of opioid misuse and addiction but also contributes to the diversion of unused pills into the illicit marketplace.
Individualized pain management
Dr. Maisie Shindo, surgical director of the Thyroid and Parathyroid Surgery Center at Oregon Health & Science University, led an initiative to reduce opioid use among patients after surgery. In an interview with Healthline, she described how her program resulted in more than half of patients—who had their thyroid or parathyroid glands removed—going home without a prescription for opioids. These patients could manage their pain with medication like acetaminophen, ibuprofen, and other non-opioid options.
While these programs aim to shift patients towards alternative pain management methods, their goal is not to eliminate prescription opioids completely. The focus is on individualizing pain management and ensuring patients are comfortable at home. Some patients may still require a small number of opioid pills, while others may not need them at all.
Managing post-amputation pain
There are also alternatives to opioids when managing post-amputation surgery pain. Most chronic post-amputation pain is due to phantom limb pain, which is neurogenic. Besides opioids, common medications include tricyclic anti-depressants and gabapentin. Newer studies are evaluating alternative drugs, such as ketamine and local anesthetics, which work by blocking hyperexcitability and sensitization.
Managing post-amputation pain can involve rehabilitation techniques such as mirror visual feedback and cognitive behavioral therapy. These adjunct therapies have proven to be effective and have minimal negative side effects.
Another way to manage post-amputation pain is through surgical means. In particular, neuromodulatory treatment and surgery for neuromas have been found to help select patients with post-amputation pain.
The bottom line
When preparing what to expect regarding post-amputation surgery pain, good communication is important between surgeons and patients. Patients should ask their surgeons about the expected pain levels, how their pain will be managed, and whether non-opioid alternatives are available. This kind of conversation is particularly essential for patients with a history of alcohol or drug issues, as they may have additional concerns and need opioid-sparing alternatives for pain management.
In conclusion, there are non-opioid pain relief options and an individualized pain management after amputation surgery can help reduce overreliance on prescription opioids. By setting appropriate pain expectations and finding alternative methods of pain control, surgeons can help prevent the misuse and diversion of opioids, ultimately contributing to the ongoing effort to combat the opioid epidemic.