If you’re heading for surgery, chances are very high that you’ll receive an opioid painkiller afterwards. That can be a significant risk for some of us, especially if you’ve been through addiction treatment in the past. Going into surgery can feel like risking your recovery and that can be terrifying. The good news is that there are plenty of tactics you can use to manage opioid usage. Opioids are one of the most commonly abused drugs in the United States. In fact, 3% of Americans misuse prescription opioids and 2% of the population or 5 million Americans have an opioid use disorder. Your doctors, nurses, and caretakers will realize what the risks are and will be on hand to help you out.
Unfortunately, having to be aware of your vulnerability to addiction will make your recovery harder. However, you can arrange most of what you need to upfront, so you have a minimum of concerns while recovering from your surgery. Let’s take a look.
Talk to Your Doctor and Surgeon
If you have concerns about using opioids, it’s important to share those concerns with your doctor. That should include any history of substance abuse (current or former), family history of substance abuse, etc. Your doctor will take your concerns seriously and chances are very high they can offer you alternatives and mitigation recommendations.
They’ll be able to go over all the other options on this list with you, which means
Consider Non-Opioid Pain Relievers
For example, depending on your surgery you might be able to skip opioid painkillers altogether. There are a few different strategies here and which you end up with will likely depend on your surgeon.
NSAIDs
It’s increasingly common to try using prescription strength NSAIDs like Ibuprofen and Naproxen instead of opioid pain relievers. These aren’t as strong, but they don’t come with an addiction risk.
In addition, it’s common to offer a few days of opioid painkillers which are then switched to NSAIDs by the time you go home. That means you’ll never take opioids without supervision.
Here, depending on the surgery and your insurance, you might also be able to prolong your hospital stay by a few days to ensure you only use your prescription medication under supervision.
Epidurals and Nerve Blocks
Local or regional anesthetics can ensure that you get pain relief without taking whole-body or systematic opioids. Here, you typically get pain relief focused on the site of surgery. However, epidurals are risky because they can cause blood clots. Your doctor probably won’t approve this unless your risk of opioid relapse is very high. Nerve blocks can also provide temporary pain relief, but generally require that you stay in the hospital for as long as you need them because they require on-site injections. However, they can provide significant pain relief without you having to take opioid medications.
There are also plenty of other “alternative” pain control methods. However, things like ginger, acupuncture, or massage therapy are not likely to help you immediately after surgery.
Consider Controlled Opioid Use
If you have a significant surgery, you might need opioids to reduce pain enough to make recovery bearable. This means you’ll want to disclose risks and your history of substance abuse with your doctor. From there, they can help you build a risk evaluation and management strategy (REMS) that works for your specific case. Depending on you that might mean:
- Minimal doses of opioids with the plan to not take opioids unless you absolutely need them. In this case, if you take every dose you have in the period, you’ll probably be asked to stay in the hospital for a few days for evaluation.
- Frequent evaluation points, where you discuss your opioid usage and how you feel about it with your doctor, pain levels, and regularly experiment with seeing how you feel without painkillers.
- Having random check-ups to make sure your opioid usage is on-schedule.
- Implementing a tapering schedule right away so you don’t use more opioids than you need at any point and are already on your way to getting off the drugs immediately after surgery.
- Wait until you need painkillers to take them. That means pushing boundaries and living with pain for as long as you can. That can decrease quality of life during recovery but might mean you feel safer about using opioids when you want to sleep or when pain gets unbearable.
- Switching to non-opioid painkillers as soon as possible can ensure that you minimize exposure to opioids and reduce total reliance on them.
If you have a recent history of drug abuse, you might also have to stay in the hospital or in a hospice for the period where you need medication. From there, your doctor might recommend that you leave the hospice and go directly to a rehab center or a sober living home to ensure that you can have the support you need after surgery as well.
Start Therapy Early
Managing pain means getting your body back into shape to do the things you want. That normally means working to get into physical therapy as quickly as possible, using alternatives to opioids as quickly as possible, and ensuring that you only use opioid painkillers when you absolutely need them.
Here, you can also generally talk to your doctor about immediately starting cognitive behavioral therapy to help you deal with pain, so you can reduce pain with physical movement and reduce pain by changing how you think about it. Both of these tactics will improve your ability to stay clean and sober – even if you do actually need the opioids for some time.
Often, both of these therapy options will be available in the hospital, sometimes as quickly as a few days after surgery. You can discuss options with your surgeon, and they will let you know when you’re ready to start.
Minimize Opioid Usage
It’s important that if you’re taking opioids, you create a plan to stop using them as quickly as possible. That can require self-control, dealing with pain, and tapering things down sooner than is completely comfortable. However, it will mean reducing your risks and ensuring that you always see opioids as something bad rather than something you’re relying on. With that mindset, you should be able to navigate post-surgery recovery without leaning too much on opioids and without forming a habit.
Opioids are addictive. In fact, you won’t get them without also getting a risk evaluation and management plan. You’ll have checkups and someone making sure you’re not using too much of your pain medication for as long as you have it. In addition, you’ll have a tapering schedule and people checking in to make sure you still need your painkillers. In some cases, you might not leave the hospital with opioids, only with prescription strength Tylenol or an equivalent.
In most cases, the best option is to talk to your doctor and your surgeon, make sure your risk management schedule takes your history of substance abuse into account, and to go into surgery knowing what your options are. You will likely need some opioids but if you go into it with care and help to keep usage to a minimum, you should be able to get through okay. Good luck with surgery!
