CINCINNATI — Kathryn Eten, an orthopedic nurse and program administrator at Good Samaritan Hospital in Cincinnati, thinks that a lot of things need to change about the way surgeons, patients and legislators deal with pain.
“One major concern a patient always has going into surgery is the fear of pain,” Eten said. “And you have to control the pain because it can affect the patient’s recoveryand lengthen their hospital stay.”
Eten described a situation, however, in which a relative of hers was told to anticipate “quite a bit of pain” following surgery but in fact found himself experiencing very little pain at all. When offered pain medication afterward, however, he still took it. As a result, this patient wound up exposing himself to potentially addictive pain medication he may not even have needed.
“The fear of pain is real,” Eten said. “And the response, typically, has been to give an opioid prescription before the surgery has even been done.”
Things were even worse when she first got started in the industry during the 1980s, Eten said.
“The whole plan back then was to go around and give everyone a pain shot every four hours,” Eten said. “There’s not one silver bullet that’s going to solve the issue of pain, but that’s what opioids have been treated as.”
These days, of course, the word opioid is most commonly associated with is “addiction.” The more opioids a patient is prescribed, the greater the possibility they may end up becoming dependent on them long-term, Eten said. And, even if they don’t, that still leaves a lot of dangerous, addictive drugs floating around out there that could potentially be stolen, sold under the counter or otherwise abused by others. In fact, at least two local candidates for political office have told stories on the campaign trail recently about loved ones who succumbed to addiction after initially being prescribed medication following surgery.
The key to curtailing surgery as a gateway to opioid addiction, Eten said, is to adopt a strategy for managing pain that attacks the problem on multiple levels.
“There are multiple pathways that the body uses to communicate pain messages to the brain,” Eten said. “You have to scramble as many of them as possible, so the body doesn’t realize that the pain is present.”
Something as simple as stretching, or getting up and moving around, can help alleviate pain, Eten said, as well as alternative treatment methods such as cold therapy and meditation. A number of non-opioid-based drugs also can be used, including over-the-counter painkillers such as Tylenol administered at prescription strength, but unfortunately, some of these medications tend to be more expensive, which is why health insurance programs like MediCare often don’t cover them.
“Historically opioids have been the go-to treatment,” Eten said. “Many of them have been around a long time, and they’re very inexpensive.”
Eten said that, in some cases, a potentially addictive opioid prescription can cost as little as $10 while non-opioids cost as much as $200 or $300. This leads to patients themselves favoring opioid prescriptions that they can easily afford.
Ultimately, Eten said, what’s needed is a combination of legislation that would make non-opioid pain medications more affordable and holistic treatment programs by surgeons and surgical teams that teach patients how to manage their expectations regarding pain.
“We need to change the language between surgeons and patients to say that you will probably have some pain, and we’re going to manage that pain in a variety of ways,” Eten said. “There has to be a realistic goal. We never say there’s not going to be any pain. It can’t be eliminated, but it can be well-managed.”
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