Gabby Reece is a professional volleyball player, sports announcer, fashion model, author and actress. She was determined to avoid the traditional post-operative use of opioids when she had total knee replacement.
She knew the pain in the first days and weeks after surgery would likely be difficult, but she also wanted alternative pain management options. Her decision is particularly newsworthy, in light of recent alarming statistics surrounding the use of opioids in America, especially opioid medications that are prescribed by physicians.
According to the National Institute on Drug Abuse, 2.1 million people in the U.S. suffered from substance use disorders related to prescriptive opioid pain relievers in 2012. The numbers of unintentional overdose deaths related to prescription opioids in the U.S. have quadrupled since 1999. Factors that have likely contributed to these statistics include drastic increases in the number of prescriptions written and dispensed, more social acceptability for use of prescribed pain relievers, and also very aggressive marketing efforts that lure consumers because they highlight opioid-based analgesics.
The U.S. accounts for almost 100 percent of the world’s total prescriptions for Vicodin (hydrocodone) and 81 percent of Percocet (oxycodone). A recent column in General Surgery News found that researchers were surprised by the number of opioid prescriptions written for even low-risk surgical procedures such as carpal tunnel release surgery, knee arthroscopy and inguinal hernia repair.
A recent New York Times article suggests a (worrisome) link between patient satisfaction scores after hospital stays and Medicare reimbursements, suggesting that doctors may be more likely to over-prescribe addictive painkillers in an effort to score higher on these patient questionnaires.
It’s important to stress that prescription opioids are similar to and act on the same brain systems affected by morphine and heroin.
Gabrielle Reece decided to have a discussion about pain and pain management with her surgeon, before he performed her knee replacement surgery. During the years of chronic knee pain, which she describes as “metal on metal,” she had dealt with her pain in a variety of ways (lifestyle, exercise, over-the-counter pain medications). She knew that no one can predict who will become dependent on opioids after a course of treatment.
Given that each year, 70 million Americans receive opioids following surgery, and one in ten patients admit they’ve become addicted to or dependent on these drugs after being exposed to them following surgery, she wanted to proactively discuss alternative pain management options. Gabby understood that pain would be a natural part of the recovery process but she made the personal decision not to take opioids to manage her postoperative pain.
Dr. Scott Sigman, an orthopedic surgeon specializing in sports medicine and the former Chief of Orthopedics at Lowell General Hospital, was very willing to have that discussion. Dr. Sigman has worked with the US Olympic/World Cup Ski Team and is the team physician for all men’s and women’s sports at the University of Massachusetts, Lowell.
In June 2016, Dr. Sigman was appointed to the Massachusetts Opioid Task Force commissioned by Gov. Charlie Baker. He is one of a group of physicians pushing for this discussion to help to limit the number of opioids being prescribed. He is passionate about patients being empowered to “have the conversation” about what level of pain may occur post-surgery, and how there are now excellent techniques and non-opioid drug options.
Dr. Sigman was clear about Gabby’s choices.
“In the context of a discussion about acute pain, like the kind Gabby was likely to experience post full knee replacement, anti-inflammatories including oral, and now more recently, injectable options, as well as anesthetics that can be directly injected into the surgical site (in this case the knee) that last for 24 to 72 hours can help to limit pain and the need for opiate level pain medications,” he says. “Individuals like Gabby, who have total knee replacement, can literally begin to walk hours after the surgery with manageable levels of pain, thanks to the (non-opioid) formulary of medications (oral and intravenous), and the lasting effects of the injected anesthetic. The worst of the pain after knee replacement surgery is typically in the first 72 hours. That pain is to a large extent managed by the anesthetic that is injected during surgery. Then oral anti-inflammatories can then help to manage the pain (once the anesthetic wears off).”
Reese understood she, like anyone, was susceptible to becoming dependent on or addicted to an opioid medication. Other athletes face similar levels of pain. For example, during these 2016 Olympics, French gymnast Amir Alt Said suffered an excruciating fractured tibia, and was scheduled to have surgery. He will likely have to make his own decisions about pain management.
Gabby said that she is aware of some athletes who had become opioid-dependent after surgery.
Reese shared how she was excited to find out that there is a new campaign focused on empowering the patient. “It’s your health, your body, so do your homework – ask questions and have the conversation to plan on how you can manage pain without opioids.”
Gabby and Dr. Sigman both offered information on a new consumer opportunity, Choices Matter, a campaign that launched on August 1 to empower the post-surgical patient. Starting the conversation about pain management can be difficult. PlanAgainstPain.com allows you to go online, fill out a questionnaire, and based on that information access medication approaches to your pain that do not have to include opioid drugs.
You can also print up your answers to the survey and bring that information to your doctor or surgeon’s office, so you are empowered to start a dialogue about your expectations of pain post-surgery. Get your doctor’s perspective. Then together, figure out a course of non-opioid analgesics for during and after surgery. Dr. Sigman points out that it’s important to remember: the goal is not to be pain-free but rather to manage the pain so that it is tolerable. He thinks that can now be accomplished with a non-opioid focused pain management plan.
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Known as The HealthGal, expert contributor Amy Hendel is a popular medical and lifestyle reporter, nutrition and fitness expert, columnist, and brand ambassador, as well as a health coach. Trained as a physician assistant, she maintains a health coach private practice in New York and Los Angeles. Author of The Four Habits of Healthy Families, you can find her on Twitter @HealthGal1103 and on Facebook at TheHealthGal. Her personal mantra is “Fix it first with food, fitness, and lifestyle.”