The United States consumes 99% of the world’s narcotic (pain medication) supply, and this consumption continues to accelerate. No compelling reasons exist for this significant volume increase. In 1990, 627,000 people used narcotics recreationally for the first time. By 2005, that number tripled to 2.2 million recreational drug users. In 2011, 50 million Americans were prescribed narcotic pain medication, which was nearly double the number in 2008. In the United States, overdose is now the #1 cause of death in young adults age 25-45. Most narcotic abusers don’t get the medications from dealers, but from friends, relatives, and physicians. This implicates physicians as prescribing excessive amounts when dispensing pain medications. Physicians must balance the need to help control pain and the risk of over-prescribing narcotics. Studies now show that increasing narcotic dosages do not correlate with pain relief and patient satisfaction. Factors that predict higher use of narcotics include anxiety, depression, smoking, and previous narcotics use. Injury severity does not accurately predict a patient’s heavy use of postoperative narcotics. The Drug Enforcement Agency (DEA) recently emphasized that “a prescription must be issued for a legitimate medical purpose by a registered physician acting with the usual course of professional practice.” Online databases have recently debuted to track physician narcotic prescriptions. US courts have indicated the following red flags may indicate illegitimate use:
No physical exam
Refills in patients suspected of selling medications
Use of street slang (eg, “Oxys” “Hydros” “Vikes”)
No logical relationship to the medical condition
Representatives of the American Academy of Orthopaedic Surgeons have recommended that any evidence of abuse should be documented in detail. Ideally, medications should be prescribed according to set protocols with defined quantities and intervals. Pain management and hospice services can be utilized when necessary. Pain medications are best used when integrated with other pain management modalities such as physical therapy, exercise, and healthy lifestyle habits.
Our practice wants to insure that our patients have adequate pain relief. For this reason, we do prescribe narcotic pain medications in the postoperative period. However, out of respect for the protection of our patients and their families, we follow standard pain management protocols. Office policies restrict our staff from deviating from these protocols. The narcotic limits we abide by are liberal enough that nearly all of our patients find they require significantly less amounts of the pain medications than what we have granted them access to. In fact, many of our patients report that they required no narcotics whatsoever. Your written prescriptions will be given to you in the hospital or in the office setting. Our office policies prevent us from calling in prescriptions after normal office hours.
Doing your part:
• Maintain a positive attitude.
• Establish relaxation and distraction techniques to calm anxiety.
• Participate in daily exercises if able to do so.
• Establish a routine to avoid frustration as normal activities may take more time.
• Move surrounding joints multiple times daily to avoid stiffness and discomfort.
• Elevate the injured extremity to decrease swelling and discomfort.
• If you have an external fixator, keep the pin sites clean to decrease irritation.
Medications to avoid:
Attempt to avoid the following medications in the immediate postoperative period as they may slow the healing process. It is ok for you to use Tylenol (acetaminophen) as directed if you have no other contraindications. Insure that your concurrent pain medications do not also contain Tylenol as it can be dangerous to exceed the maximum daily dose.
• Children's Advil
• Indocin (SR)
• Indochion (E-R)
• Indomethacin (SR)
• Tolectin and
• Tolectin DS
Much of the information above was derived from the following article:
Sohn D. Pain Meds Present Problems. AAOS Now. Jul 2013.