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    Preventing Opioid Use After Surgery 

     

    The goal for post-surgical pain management is just that: manageable, not pain-free. Hospital use of opioids during surgery and immediately after is essential. However, the slower-acting oral pills used after discharge home increase risk when taken for more than three days. More importantly, they rarely relieve pain better than other options.

    Here are plans and the logic behind how to use #OptionsNotOpioids

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    Resource Menu Links

    Why Recover from Surgery Without Opioids? - ERAS Hospitals - Surgery Specific Prevention Tools - 
    Downloadable Resources - Opioid-Sparing Video Bootcamp - Advocacy Links

     

    Free Pain Plans: Oral Surgery - Knee Surgery - Arm Surgery - General Surgery 

    Buy Products: Oral Surgery Bundle - Knee Surgery Bundle - Arm Surgery Bundle - General Surgery Bundle

    Pain Care Labs' Mission - Eliminate Unnecessary Pain ... and opioids. We know some pain is unavoidable. We know opioids improve lives, reduce the development of PTSD and chronic pain, and facilitate procedures and surgeries. We also know that unnecessary pain and opioid use lead to suffering and loss. There is no one right answer. While we founded the field of thermomechanical pain relief, we support every evidence-based pain intervention - and want you to know about them all, and how to use them to eliminate opioids after surgery.

     

    • The Logic Behind Home Surgical Recovery Without Opioids

      Opioids don't turn off pain. Instead, morphine strongly activates reward receptors in the brain, "switches" that release all the dopamine "feels" of power and accomplishment. The receptors overlap with many pain processing areas, so while you may feel pain, you aren't distressed because you feel in control. The body reacts to stress and pain quickly, increasing pain sensitivity: learned memory pathways intended to help you avoid pain in the future.

      • Helpful in the hospital - The amount of morphine in the first 24 hours after trauma, burns, or severe injury has been shown to reduce PTSD and chronic pain, potentially by reducing stress with dopamine. 

      • Home pills post-op work differently - After a few days, though, the brain's reaction to opioids changes. There are five reasons why oral opioid pills after surgery work differently than the IV formulations given at first:

      • 1) After a few days, the brain dopamine switches don't respond as much to opioids.

      • 2) A newly discovered switch that prevents chronic pain is only effective in the first few days.

      • 3) Your body has to convert pills to the active morphine form. Some people convert too slowly to release much dopamine.

      • 4) Some people don't process dopamine well, or convert opioids so quickly they feel disproportionately powerful and accomplished with the dopamine rush... an OUD risk.

      • 5) Opioids disrupt deep sleep, a key component of healing and coping with pain.
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      • What works for home pain relief? Most compelling, post-surgical studies don’t show a benefit with home opioids compared to coaching, a pain plan and options. For wisdom teeth extractions, multiple studies showed ibuprofen superior to codeine. Sadly, one study found that of young adults prescribed opioids for wisdom tooth (3rd molar) extractions, 6.4% were still on opioids 90 days later.

        For pediatric fractures, ibuprofen was at least as good as opioids for pain relief. For carpal tunnel release, hand surgeries, and general surgeries from cholecystectomy to robotic prostatectomy, over-the-counter pain medication and a pain plan was sufficient or superior. The only difference was opioids increase side effects. Knowing it is possible and preferable to recover without home opioids - if this is what you decide to do, what's the plan?                                         

      • Oral surgery (wisdom tooth removal, 3rd molar surgery)
      • Knee surgery
      • Upper extremity (wrist, elbow) surgery
      • Other surgeries
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    • ERAS (Enhanced Recovery After Surgery)

    • Hospitals and doctors have realized that the biggest source of the opioid crisis is unused overprescribed opioids, and that there are better options for pain and recovery. Many hospitals are implementing plans to use non-opioid medications, and the really progressive ones are providing coaching and pain plans for aftercare.
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    • What is an ERAS Hospital?
    • Enhanced recovery after surgery (ERAS) is an evidence-based approach to surgical care aimed at minimizing the stress of surgery and supporting patients to recover quickly . To understand why ERAS is a preferred method, refer to the ERAS Society's Patient Information page. 

     

    How ERAS Improves Care

    • Surgery-Specific Prevention Tools

    • Each plan goes through pre-surgery preparation, how to plan over-the-counter medications or supplements, and physical options. To learn specifically about how and why options help with pain, read our Personalized Pain Plan page. 

    • Oral surgery

    • Download our oral surgery pain plan checklist.
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    • - Get multiple options together for comfort. Ice, vibration, and compression are likely to work better than heat.
    • - Pain may start a few hours after the surgery when the numbing medicine wears off, and last for several days. Have a comfortable place to sleep with distractions and comfort items close at hand when you get home. Take ibuprofen as soon as possible afterwards so it will be reducing inflammation when the injected pain relief wears off.
    • - Ibuprofen and acetaminophen (paracetamol) have as good or better pain relief than oral opioids, with lower side effects.
    • - The pain medication injected for the extraction may or may not be given awake. If you're awake for the injections, use a Buzzy or the vibration unit inside a VibraCool on the cheek or jaw bone to reduce the pain.  
    • - Consider alternating long-acting acetaminophen with ibuprofen, or using it before bed, or take short-acting if the physical interventions aren't helping enough and it's not time for more ibuprofen yet. 
    • - Finally, have as many video games, distractions, treats, and other pleasant activities or sensations available as possible.
    • Check out the free download of What Works for Pain.
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      • Knee surgery

      • Download our knee surgery pain plan checklist.
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      • Preparation for knee surgery begins well before surgery. To learn more about pre-hab (strengthening before surgery), see the video below. Learning and practicing relaxation techniques before surgery also helps increase control and reduce fear, key aspects of pain management. A video of one easy and fast relaxation and breathing trick is below.
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      • Unless you have a specific history of opioid use disorder, opioids during surgery and in the hospital are totally appropriate. Set your expectation for post-surgical pain management to “manageable” or “more comfortable”, not pain-free. 

        For home pain relief, many people do really well, and you might have very little discomfort. Having options and a plan if you experience more than a little is the key - more comfortable home recovery opioid-free is absolutely attainable!
    VC Post-Surgery Ext + Flex_testimonial
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      • - Consider alternating long-acting acetaminophen with ibuprofen, or using it before bed, or take short-acting if the physical interventions aren't helping enough and it's not time for more ibuprofen yet.
      •  
      • - The sooner you're up and moving, the better. Clear a place and add supports to enhance moving.
      •  
      • - Ask your surgeon how long it will be until you're back to normal; plan enough pleasant activities, distractions, and new options for at least half that time.
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        The What Works for Pain workbook can be downloaded FREE to create your personalized pain management plan. Pick at least three options to try in each section beforehand. There is NO one sufficient intervention for pain. Part of what makes a pain plan effective is the decisions you put into it, and the control of having multiple options to try. 

        If you want to try vibration and ice, the VibraCool Extended is the over-the-counter unit we recommend. We also have a professional two-unit Lower Extremity kit with heat, ice, and a physical copy of the What Works for Pain workbook.
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      • When the block wears off, center the VibraCool unit above the back of the knee where the bandages stop. If using the VibraCool Pro, slide the two units until you're most comfortable (the pain signal is maximally blocked). Thermal mechanical stimulation options appropriate for knee surgery are in a bundle available here:

      • Upper extremity (wrist, elbow) surgery

      • Download our arm surgery pain plan checklist.

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      • Preparation for wrist or elbow surgery involves thinking about everyday activities you do with that arm, and making accommodations in advance. By planning for one-handed normal activities, you're less likely to get overwhelmed, which increases pain.
      •  
      • Learning and practicing relaxation techniques before surgery also helps increase control and reduce fear, key aspects of pain management. A video of one easy and fast relaxation and breathing trick is below.
      •  
      • Unless you have a specific history of opioid use disorder, opioids during surgery and in the hospital are totally appropriate. Set your expectation for post-surgical pain management to “manageable” or “more comfortable”, not pain-free. 

        For home pain relief, many people do really well, and you might have very little discomfort. Having options and a plan if you experience more than a little is the key - more comfortable home recovery opioid-free is absolutely attainable!
    VC-E Post-Surgery Wrist_Testimonial2B
      • - Consider alternating long-acting acetaminophen with ibuprofen, or using it before bed, or take short-acting if the physical interventions aren't helping enough and it's not time for more ibuprofen yet.
      •  
      • - Ask your surgeon how long it will be until you're back to normal; plan enough pleasant activities, distractions, and new options for at least half that time. Because protecting your arm or wrist often leads to extra stress on the shoulder, make sure you have lots of pillows of different sizes and weights to prop yourself/your arm without hurting the shoulder. A 10% menthol preparation like StoPain can be rolled on the neck and shoulder muscles if they get tense and hurt in compensation.
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        The What Works for Pain workbook can be downloaded FREE to create your personalized pain management plan. Pick at least three options to try in each section beforehand.

        If you want to try vibration and ice, the VibraCool Easy-Fit is the over-the-counter unit we recommend. The D-ring on it allows for one-handed attachment. We also have a professional two-unit Upper Extremity kit with heat, ice, and a physical copy of the What Works for Pain workbook.
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      • When the block wears off, center the vibration unit above the location on the arm where the bandages stop. Thermal mechanical stimulation options appropriate for wrist or arm surgery are in a bundle available here: Arm Surgery Bundle

      • Other Surgeries

      • When you have time to plan: 
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    • Download our surgery pain plan checklist.
    •  
      • The What Works for Pain workbook can be downloaded FREE to create your personalized pain management plan. Pick at least three options to try in each section beforehand. There is NO one sufficient intervention for pain. Part of what makes a pain plan effective is the decisions you put into it, and the control of having multiple options to try. 
      •  
      • Learning and practicing relaxation techniques before surgery also helps increase control and reduce fear, key aspects of pain management. A video of one easy and fast relaxation and breathing trick is below.
      •  
      • Unless you have a specific history of opioid use disorder, opioids during surgery and in the hospital are totally appropriate. Set your expectation for post-surgical pain management to “manageable” or “more comfortable”, not pain-free.
    https://shop.paincarelabs.com/pages/general-surgery-build-your-own-bundle
      • When you don't have time to plan: 

      • Even for emergency surgeries or trauma, by the time you're home the worst is over! For home pain relief, many people do really well, and you might have very little discomfort. Having options and making a plan when you're in a comfortable moment in case the pain escalates is the key - more comfortable home recovery opioid-free is absolutely attainable!
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      • General Advice:
      •  
    • Before discharge, ask your surgeon how long it will be until you're back to normal; plan enough pleasant activities, distractions, and new options for at least half that time.
    •  
      -Consider alternating long-acting acetaminophen with ibuprofen, or using it before bed, or take short-acting if the physical interventions aren't helping enough and it's not time for more ibuprofen yet.
      •  
      • -The sooner you're up and moving, the better. Clear clutter and add supports to enhance moving, or have someone do it for you if the surgery wasn't planned. 
      •  
      • - For abdominal muscle pain after surgery or cramping in muscles that support the hips or torso, heat + vibration may work better. The VibraCool Flex unit has a pocket for the vibration unit, with both an ice pack and a heat pack to try. 
      •  
        Additional long ice packs to slip over shoulders may help pain in other muscles that get painful trying to stabilize the surgery site. We also have a physical copy of the What Works for Pain workbook to find other physical and brain-body options.
      •  
      • Thermal mechanical stimulation options appropriate for general or hip surgery are in a bundle available here:

    Downloadable Resources

    • Opioid-Sparing Video Bootcamp

      Prepare & recover from surgery:
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    • Advocacy links

    • US Pain Foundation 
    • Pain is personal - effectively managing pain involves a personalized approach in partnership with healthcare providers to discover a combination of therapies that enhance your quality of life and functionality.

      • Voices for Non-Opioid Choices
      • Your voice is critical in expanding access to non-opioid options to manage acute pain for patients and providers around the country. Learn about the ways to get involved!

      • NOPAIN Act
      • The Non-Opioids Prevent Addiction in the Nation Act (“NOPAIN Act”) is a policy that will prevent opioid addiction before it starts by increasing the use of non-opioid pain management approaches in outpatient surgical settings by changing outdated federal reimbursement policies.
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    • Melissa vs Fibromyalgia 
    • Melissa helps women with chronic pain and fatigue put self-care & wellness first.
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    • Yoga with Adriene
    • Yoga and movement have been shown to help relieve pain. This YouTube channel is one of the largest free, online communities with high-quality yoga and mindfulness practices. 
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    • The Meg Foundation for Pain
    • Empowering families with skills, strategies, and support systems they need to help children manage pain and medical anxiety.

    • Heart's Connected
    • A supportive partner for coping with and healing from the unexpected and unpredictable challenges life presents to us all through therapeutic play and interventions.

    Behavioral Medicine Education and Relaxation: Dr. Judith Scheman

    This educational video was designed to help patients get better, faster after their surgery. This is part of the new Behavioral Medicine Program- a program unique to Cleveland Clinic that offers a holistic and integrated medical and surgical care approach. This session helps prepare you for surgery and facilitates a smooth recovery after surgery. 

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    Dr. Judith Scheman and the Five-finger breathing technique

    Five-finger breathing is a simple, powerful breathing technique for deep relaxation and pain relief. Pain specialist and behavioral medicine psychologist Dr. Judith Scheman, Ph.D., explains how to do it in order to relax, unwind and manage pain.