When Pain is Definitely No Gain
How about better helping patients manage pain when it really counts now and then – such as in surgery or during medical procedures? This may also make a real dent in the opioid crisis, which is largely fueled by prescription drugs. The majority of surgeries are now performed in outpatient settings or fast track admissions. That often means that a patient is discharged home after just barely recovered from what was done and the drugs that were given for pain and anxiety management haven’t completely worn off. At that time, neither the patient nor their doctor may know what the recovery drug needs of the patient will be and how much coping support will be needed. The simple time-saving solution then becomes a standard subscription of lots of opioids.
Paradoxically, the patients who get the most drugs to manage discomfort on site and don’t need to learn to cope may do the worst when they are left to their own devices at home. In a Swedish study, patients who were scheduled for abdominal hysterectomy were randomized to either have general anesthesia, where they were “out” during the procedure, or spinal anesthesia, where they had medication instilled in their spinal cord to numb the operating field but were awake (1). Afterwards during a recovery in the hospital for an average of 2 days, patients pretty much got the same standard amount of opioids administered. Once at home, however, the women who had prior general anesthesia took 8 times as many opioid pills than those who had been awake and had to learn to cope in one way or the other. The difference was 23.9mg vs 3 mg morphine equivalent! One can see how that such a difference can produce vastly different addiction risks. Also recovery can get more sluggish with more drugs: with 23.9 mg morphine one can expect some side effects such as being drowsy, constipated, and possibly not as eager to get up and get around.
The same Swedish study also looked into patients’ innate coping abilities. Those who came with high stress coping skills recovered faster and had fewer postoperative symptoms than those with low stress coping skills. But that only held true for those who had the spinal anesthesia – not those who were “out.” How much simpler though would it be to provide patients coping skills right at the time when they have procedures and allow them to test what works while they have the safety blanket to get some extra IV drugs. This is what I have been working for the last 20 years when developing Comfort Talk® to help patients cope quickly on the operating table so that they will do well even if they don’t arrive with perfect stress coping skills already. This approach also allows to better assess how much drugs patients need, whether they may get along with regular Tylenol, and/or anti-inflammatory medications, and adjust the prescriptions afterwards. There is no need having lots of “extra” opioids lying around at home for people who don’t need them and have them fall in the wrong hands and cause havoc on their lives. On the other hands, people who need opioids, should get them prescribed in the quantitates that are right for them, without having to fear to be left suffering. This is not abut an either/or – it is about the right balance.
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