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Five things to know about pain control for surgery

Pre- and post-surgical pain management can include various methods. While taking opioids safely can be a viable option to treat pain, the current epidemic has shifted focus to alternative methods to help people heal.

Here's what you should know about surgical pain management.

1. Opioid use can be effective, but long-term use can be harmful

Opioid pain medications are very effective in controlling acute pain from injury or surgery, but long-term use can be harmful and dangerous. Opioids work in the spinal cord and brain, essentially closing a door and preventing pain from passing through. Unfortunately, because pain is our body's natural warning sign, unless the root cause of the pain is treated, it will knock harder and harder until it gets through. Long term, more opioids will be required to treat the pain and cause adverse effects on your body including: constipation, nausea, sedation, and hormonal imbalance leading to low testosterone or osteoporosis. It can even stop breathing and may result in death.

2. Long-term opioid use makes patients more sensitive to post-surgical pain

Minimizing or even eliminating use of opioid pain medications weeks to months prior to surgery can help normalize pain receptors so that pain can be more effectively treated after surgery, which can help optimize recovery. It is often helpful to speak to your physician about how to achieve that goal.

3. Consider effective pre-surgical pain management alternatives

There are effective non-opioid pain treatment options that can be used prior to surgery. Many times, the reason for surgery is to treat the problem causing the pain. But instead of relying on opioid pain medications, there are good alternatives. Often Tylenol, NSAIDs, and nerve pain medications can be used to help minimize opioid use and also treat the pain prior to surgery. There are also nerve blocks, and ablations that can be very helpful. These minimally invasive procedures target pain at the source and its effects can often last into the postoperative period and help recovery.

4. Utilize nerve blocks and ablations for knee surgery

Nerve blocks and ablations can help treat pain before and improve recovery after knee surgery. There are nerves in the knee that have little role but to cause the pain of knee arthritis. A minimally invasive procedure can be performed to block and ablate these nerves weeks to months prior to knee replacement surgery, so that the knee pain is minimized. This can help minimize the use of opioid pain medications leading into knee surgery and its pain relieving effects can be sustained after the surgery so that rehabilitation exercises can be done with less pain.

5. and other procedures too

Many other nerve blocks can be done on the day of surgery so that pain is controlled during and after surgery with minimal use of opioid pain medications. The anesthesiology team can often perform a quick, safe, image-guided procedure that can numb the exact nerves in the region of surgical. This can be done for orthopedic, abdominal, thoracic and many other surgeries. The effects of the nerve block starts right before surgery and often lasts hours to days after surgery. This is often the most painful period and can dramatically lower the amount of opioid pain medications needed during and after surgery.

Yili Huang DO, is director of the Pain Management Center at Phelps Hospital and assistant professor of anesthesiology at Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. He is a double board-certified pain management anesthesiologist who completed his medical training at Yale and Cornell and co-leads the Opioid Practice Guidelines Workgroup as part of the Northwell Opioid Task Force.

"Minimizing or even eliminating use of opioid pain medications weeks to months prior to surgery can help normalize pain receptors so that pain can be more effectively treated after surgery, which can help optimize recovery."
— Yili Huang, DO
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