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Managing Postoperative Pain During an Opioid Epidemic

 

Opioid prescription pain medicines (opiates) are a type of medicine commonly used to reduce or relieve pain. Common types include oxycodone, hydrocodone, codeine, and tramadol. These medicines are often combined with acetaminophen (Vicodin, Percocet). These medications are highly addictive, particularly if they are not taken as directed by your provider. In addition to overdose, other common side effects include nausea, itchiness, constipation, sedation, and agitation.

In accordance with new state regulations regarding opioid prescription pain medication, we have updated our policies at Ortho RI. Following your surgery, an opiate may be provided to reduce pain in the early postoperative period. We are required to check the RI Prescription Drug Monitoring Program (PDMP). This is a statewide database that tracks all controlled substance prescriptions you have received from any and all providers.

Additionally, all patients receiving an opioid prescription will also get an information handout from the RI Department of Health entitled “Knowing the Risks of Opioid Prescription Pain Medications”. The state also requires that a naloxone (opiate “antidote”) prescription be provided to patients who 1) receive large doses of narcotic medication, 2) are also taking a benzodiazepine such as Valium or Xanax, or 3) have a prior history of abuse or overdose.  Since it is nearly impossible to accurately identify which patients meet these criteria, all patients will receive the naloxone prescription. You do not need to fill this prescription unless one of these circumstances applies to you.

In some cases, you may receive two separate opioid prescriptions. For patients who have not been prescribed an opiate recently (within the previous 30 days), you may not receive more than twenty pills in the first prescription. We understand this may not be enough to last until your first postoperative visit, and thus a patient undergoing a more extensive procedure may receive a second prescription to be filled in the interim but not sooner than the date on the second prescription. It is important to never share your prescription with anyone. Do not take a higher dosage than prescribed by your healthcare provider.

It is important to remember that the role of pain medicine is to relieve the severity of your postoperative pain, not to eliminate the pain. Non-opioid options such as ibuprofen (Motrin), naproxen (Aleve), and acetaminophen (Tylenol) should be used as first line agents when appropriate. Other modalities such as ice, acupuncture, cognitive and behavioral therapy, and meditation can also provide pain relief.

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