Doing no harm

Written by Paul Sethi

According to the Centers for Disease Control and Prevention, 44 people die every day in the United States from an overdose of prescription painkillers. This troubling statistic has ignited the search for pain-management alternatives among many surgeons, who are unsettled by the idea that a prescription for hydrocodone or oxycodone that is intended to help a patient recover from surgery could lead to a lifelong battle with addiction or even death.

For the past eight months, my colleagues and I have been successfully using a new pain-relieving method in knee and shoulder surgeries that helps reduce or eliminate a patient’s need for opioids to control postsurgical pain. By injecting a new, slow-release local analgesic into the deep tissue around the bone and the muscles that surround the operation site, we are able to numb it for 72 hours after surgery, the most critical period of intense pain.

Some patients who have been administered the analgesic have not needed any narcotics for pain, or, if they did, they’ve needed far fewer than with traditional postsurgical pain control. Since those patients take painkillers for a much shorter period of time, the risk of addiction is greatly reduced, as is the risk that unused pills will fall into the hands of friends or loved ones. Currently, about 70 percent of prescription opioids used for nonmedical reasons are obtained through family or friends, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).

In the past, recovery from total shoulder replacement surgery has usually required weeks of pain and opioids to control it. This was not the case for Manhattan resident Marjorie Purnick, who was out to dinner with friends the night after her procedure, which included the administration of the numbing medicine. She said she has never taken a single pill for pain in the four months since her shoulder replacement surgery.

“It was incredible. I kept waiting for the pain to hit, but it never did,” she says. “Friends who have had the same surgery don’t believe me when I tell them that I had no pain.” With the help of physical therapy, Marjorie has regained close to 100 percent of her range of motion, a recovery that she says has been four to eight months quicker than her friends. “I think I’ve recovered so quickly, because I didn’t have pain holding me back. I could get started with therapy right away.”

Vivid memories of the agonizing pain that Rye resident Michele Herrera had endured following a surgery on her left shoulder five years ago had been preventing her from undergoing surgery to correct torn biceps and bone spurs in her right shoulder.

“I was petrified to have the surgery again because of that pain,” she recalls. This time around, however, it was completely different. “I am the happiest person in the world. I had surgery and I was out walking the dog that same day.” When the medication did start to wear off three days later, she says she took pain medication, because she was afraid of how intense the pain would be. She soon realized that all she felt was a little sore. “Once I realized the pain was manageable, I switched to Tylenol.”

These types of results and the successes of other opioid-sparing efforts in this country are cause for cautious optimism that we can control at least the physical reason for opioid addiction. Still, we still have a long way to go. It is incumbent on the medical community as a whole to recognize its own responsibility and do the right thing for patients. Newer pain protocols will initially add to a physician’s costs, but if it can save a person from an overdose death or a lifelong addiction, it’s well worth the price.

I would do that for my patients any day of the week.

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