Managing Pain Safely

July 07, 2021

Finding Non-Opioid Relief from Pain 
Dependence and addiction to opioids is, unfortunately, nothing new. But medical providers are working diligently to educate patients about the risks of opioid addiction following surgical procedures, suggesting alternatives, and limiting the number of medications prescribed. 

One of those providers in our community is physiatrist Dr. Natacha Falcon of North American Spine and Pain in Somers Point. She cares for patients who are experiencing pain due to injury, illness, or medical conditions. She predominantly uses physical therapy, medications, modalities, bracing and interventional procedures to help her patients recover their functional wellbeing and improved quality of life. .  

Addiction Can Occur Quickly
Patients who experience significant pain after a surgical procedure may be prescribed opioids to manage their pain on a very short-term basis. According to Dr. Falcon, opioid addiction can occur in as little as five days. The rate of long-term opioid use increases for patients who take them for eight days or more.  

She added, "The risk of opioid misuse in patients prescribed opioids for acute post-surgical or post-procedural pain is relatively small at approximately 0.6% annually. However, more recent data from hospitals and surgical centers report 48 million surgeries or procedures are done annually. That translates to 160,000 patients who may misuse, abuse, or overdose each year."

Dr. Falcon explained that short-term opioids can help improve pain and therefore improve functional ability for post-operative patients, aiding in recovery and rehabilitation. However, studies have shown opioids are associated with a suppressed immune system, depression, lethargy, and increased sensitivity to pain despite increasing doses of opioids. 

"Overmedicating can interfere with recovery, so it is important to prescribe responsibly. Too much medication can lead to an altered mental status, lethargy, constipation, and respiratory depression. The goal of treatment is to bring the pain down to a tolerable level that allows for maximal functioning, with the lowest risk of side effects, misuse or abuse," said Dr. Falcon. “That does not mean pain-free.”

Pain Can Affect Us Differently
Some research indicates that women are more sensitive to pain than men and more likely to have chronic pain. That could be the reason for the high rates of opioid prescriptions among women of reproductive age, according to Dr. Falcon. 

"Women are likely to use more prescription opioids than men. Women's death rates from prescription opioids are rising much faster than the death rate of men. However, more men still die of opioid abuse." 

Dr. Falcon provides some other sobering statistics about prescription opioid overdoses.  

"In 2016, there were 7,109 women and 9,978 men who died from a prescription opioid overdose. That is roughly 19 women and 27 men overdosing daily on prescription opioids. Women ages 45-54 are more likely than any other age group to die from a prescription opioid overdose."
 
Over 65 And Experiencing Pain
Aches and pains are part of life, but for many, getting older comes with increased discomfort and surgeries, such as joint replacements. Dr. Falcon said 4% to 9% of adults age 65 and older use prescription opioid medications for pain relief. She added that from 1995-2010, opioids prescribed for older adults during regular office visits increased by a factor of nine. 

Nearly one million adults over the age of 65 have a substance abuse disorder, according to data released in 2018. Older adults may be more at risk for side effects of drugs and are more likely to misuse medications, unintentionally forgetting to take medications as prescribed. To avoid that, Dr. Falcon said screening for opioid abuse risk factors is essential. Physicians should consider the patient's physical and psychological history and assess for concurrent substance use and mental health disorders that could increase their risk for opioid use disorder and overdose. She added that many tools have been developed to assess a patient's risk of having substance abuse problems.

Being honest with patients is another tool to help them understand their pain. 

"It is important to set up realistic expectations with patients for their recovery," said Dr. Falcon. "Educating patients about the different approaches to pain management and the risks and benefits of the various classes of medication is important. Patients who are taking opioids before surgery may have more difficulty managing their pain post-operatively. Patients need to know that opioid addiction can occur in as little as five days. They should also understand non-opioid medication and modality options," said Dr. Falcon. 

Balancing Physical and Psychological Factors
Dr. Falcon said weaning patients off of opioid medications is a delicate balance of managing the physical and psychological factors. "It is important to educate patients on the risks of opioid use, abuse and addiction and offer other treatments to improve pain and function. Often patients are amazed at how much better they feel. Many are grateful their physician cared enough to have those sometimes-difficult conversations with them," said Dr. Falcon.

One technique to control pain and decrease opioid use in the first 24-48 hours is a peripheral nerve block, commonly used to control site-specific pain right after surgery. Another post-operative pain control treatment includes low-dose opioids, anti-inflammatories and acetaminophen. 

To deal with post-surgical pain, Dr. Falcon said patients benefit from a combination of pain relief medications for post-acute surgical pain and chronic pain. She went on to say that medications from different classes can work well together and reduce side effects. Several days after surgery, it is crucial to monitor and discuss opioid use and begin weaning the medication. 

Non-opioid Alternatives
For her patients, Dr. Falcon suggests non-opioid medications including acetaminophen (Tylenol), NSAIDS (i.e., Ibuprofen), muscle relaxants, anticonvulsants, (nerve medications), topical NSAIDS/lidocaine/capsaicin or patches, or medical marijuana. Other non-medication treatments include ice/heat, elevation/compression, physical therapy, massage, yoga, acupuncture, bracing, interventional procedures and transcutaneous electrical nerve stimulation (TENS) machine. 

To schedule an appointment with Dr. Natacha Falcon, call 855-862-7767 or email info@naspacmd.com. Dr. Natacha Falcon, DO, is Board Certified in Physical Medicine and Rehabilitation, and Fellowship trained in Interventional Spine. She is on staff at North American Spine and Pain, 700 Shore Road, Somers Point, NJ.