Orthopedic Surgeons Seek Opioid-Alternatives For Pain Management

Recently, there has been a push in the orthopedic community to “investigate and explore alternative strategies to keeping patients comfortable after surgery,” according to Nady Hamid, MD, of the Shoulder and Elbow Center at OrthoCarolina and department of orthopedic surgery at Atrium Health. The American Academy of Orthopaedic Surgeons has been at the forefront of addressing the opioid epidemic and has provided instructional course lectures, patient safety tool kits and position statements to educate physicians and the public on the use, misuse and abuse of opioids within orthopedics, he said.

Orthopedics Today, May 2019

Additionally, legislation is being passed on the state level to set limits on opioid prescribing based on the CDC recommendation of a 7-day supply maximum. This can however create a set of additional challenges in highly restrictive states. 

Hamid has looked at alternative opioid-fee solutions, which he claims are the “holy grail” of post-surgical pain treatment.  The goal is to have patients recover comfortably from surgery without “having to deal with all the side effects that come with opioids.”  His suggestion on the best way to impact the epidemic is to change “our postoperative protocols and strategies to where we eliminate the prescriptions to be written in the first place.”

opioid

According to Paul E. Hillard, MD, medical director of Institutional Opioids and Pain Management Strategy, physicians “currently use a multimodal approach for pain management” which “starts prior to surgery with educating patients on the concerns around opioid use.” Other physicians agree that patient education plays a key role in setting expectations and identifying potential risks for developing substance use disorder.  Additional options like drug monitoring programs and utilization of EMRs may help reduce unnecessary or over-prescribing of opioids.

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