After a surgical procedure or serious injury, all you want to do is rest and recover as quickly as possible. But, boy, pain sure can get in the way.
It hurts to move. It hurts to be still. Ugh, it even hurts to breathe.
While your doctor has likely prescribed you medications to help ease your discomfort, you’ve probably seen recent headlines about the opioid epidemic and have some concerns about how safe it is to take those pills. Will they make you feel out of it? Can you develop an addiction? Is it possible to accidentally take a lethal dose?
“We don’t want people to become addicted to medications for the long term,” says Dr. Katherin Peperzak, an anesthesiologist at Harborview Medical Center’s Pain Center. “That said, pain medications do work when we’re prescribing the appropriate amounts for an appropriate duration, and patients should feel safe to use them.”
To help address your concerns — and discuss what medical professionals are doing to keep you safe — Peperzak explains the ins and outs of pain medication.
Types of pain medications
The most common type of pain medication you’ll receive after surgery is actually something you’ve probably encountered before: over-the-counter medications. Think acetaminophen like Tylenol or a nonsteroidal anti-inflammatory drug (NSAID) like aspirin or ibuprofen.
Acetaminophen is generally safe and has very few side effects, while NSAIDs are also safe but may cause heartburn or stomach irritation. In some cases, NSAIDs can also affect your kidneys or create a bleeding risk, so doctors will do a thorough health assessment before deciding which one to prescribe to you.
Wondering why you’re only getting over-the-counter medications when you’ve just had surgery? That’s because these drugs are often given in much higher doses at the hospital.
“Acetaminophen is remarkably effective when it’s given in reasonable doses,” Peperzak says. “In the hospital, we use up to 1,000 milligrams, and at home, it’s usually only 325 milligrams per dose.”
Your doctor may also prescribe a drug called gabapentin. This is a medication that doctors often use to help you deal with nerve-related pain or sensitivity. For this drug, the most common side effect is sedation.
Another commonly used medication for post-surgery recovery is an opioid, a powerful drug that binds to receptors in your nervous system and changes how you perceive pain. These drugs can be given in the hospital via an IV (think morphine) or may be prescribed to you in pill form, like oxycodone, Dilaudid or Percocet. Common side effects include sedation, nausea, itching and constipation.
You may be prescribed all of these medications and more or only a few of them. Either way, it will always be under the careful watch of an anesthesiologist and surgeon.
“In general, pain medication has gone toward a multimodal approach,” Peperzak explains. “We use medications that are working on different receptors and are from different classes, and then gradually peel those off as you recover, getting rid of higher risk medications as you go.”
Medication precautions before surgery
If you’re scheduled for surgery, your medical team may talk to you about what medications, if any, you’re already taking. That’s because some types of drugs, like anti-inflammatories, can increase your risk of bleeding or hinder wound healing.
However, depending on the type of procedure you’re having, your doctors may not ask you to stop cold turkey. Peperzak says she’s found patients who have well-controlled pain before surgery tend to do better after their operations.
“We used to think patients would be more successful if we weaned down their chronic opioids before surgery, but we think it might actually be a negative,” she explains.
In essence, it can be more difficult to control pain after your surgery if you already have uncontrolled pain before the procedure.
Talk with your doctor if you have questions about stopping or continuing your pain medication regimen.
Measuring pain after surgery
After an operation, your team of doctors and nurses will try to gauge your pain in two main ways.
One is by asking you to score how you’re feeling on a number scale — the higher the number, the higher your level of discomfort.
Although this self-assessment technique gives your medical team helpful insight into how you’re feeling each day, it can also be difficult for them to moderate and qualify. After all, one person’s eight may be the same as another person’s four.
For that reason, they also look at how well you’re able to complete tasks and perform regular movements.
“We look at things like are you able to get up to go to the bathroom?” Peperzak says. “Can you make it through physical therapy? Essentially, are you meeting functional goals?”
Once your medical team can see how you’re handling your pain, they’ll be able to tailor the types and amount of medications you need.
Understanding pain medication safety concerns
If all this talk about opioids has your ears perking up, that’s because you’ve likely heard about the dangers of becoming addicted to or overdosing on this type of drug. And it’s a concern that anesthesiologists, pain experts and surgeons share and take into consideration when deciding what to prescribe to you.
“We don’t want to create new chronic opioid patients, and we also want to avoid putting more opioid medication into the community through diversion,” Peperzak notes.
To help make sure they’re prescribing a safe amount of opioids, prescribers look to state guidelines, which estimate how long it takes to recover from different types of surgeries. This gives your doctors a general time frame for how long you’ll need to be on pain medication.
“Through the guidelines and also some insurance restrictions, the number of opioid tablets that people are leaving the hospital with is now much smaller,” Peperzak says. “And if patients are not recovering as expected, there are methods in place for them to receive refills of medications.”
Doctors and chemical dependency counselors at Harborview are also working hard to identify people who may have an opioid-use problem when they come into the hospital. If someone is addicted or at risk for addiction, their medications are closely monitored and tapered off on a structured schedule.
Aside from potential drug dependencies, another safety concern with medications is an accidental overdose.
“We definitely want people to avoid alcohol when on these medications, and we also worry about other prescribed medications like the Ambien sleep aid or benzodiazepines for anxiety,” Peperzak says.
To reduce your risk, it’s important to be upfront with your doctors about what medications you’re taking and to also follow their instructions about how much to take at any one time.
Alternative pain relief options
Aside from pain medications you might take in the hospital or at home, there are alternative options that your doctors may also recommend.
“We are very much proponents of alternatives to pain medication at Harborview,” Peperzak notes. “We have a multidisciplinary team, so our pain team meets with other disciplines like acupuncturists who offer treatments to our pain patients.”
Harborview also turns to rehabilitation psychologists to work on distraction techniques, guided imagery, music therapy and hypnosis, as well as spiritual care teams who can sit and talk with patients about their faith or general mental health.
“We really try to get many different disciplines involved and not make it just about the medications,” Peperzak says.
The bottom line
It’s never fun having to deal with pain, and worrying about how safe your medications are isn’t fun either.
But asking questions about the mediations you’re prescribed — and always following proper instructions about how much to take — can help put your mind at ease.