Page 13 - CASA Bulletin 2019 Vol 6 No 4

Vol.6, No.4, 2019

Opioids are considered to be the best pain relief for acute pain. So it is given after acute
injury and surgery. Sometimes pain medication are used as part of anesthesia during surgery
and continued after the procedure during the healing time to ensure patient is comfortable
and remains pain-free. However, this has unfortunately led to many opioid addictions, as it
has shown over and over again that many addictions started after surgeries. Continued use for
prolonged period of time is associated with significantly increased rate of opioid addiction,
compared to short-term use after surgery or people have never used opioid. As some studies had

shown addiction can happen within a week’s use or - as soon as 5 days, I have seen surgeons
now are not willing to give opioids, or limiting the post-operative prescription to 7-10 days in
combination of NSAID. Patients are instructed to titrate the dose at early days.

It is important to know some people are at higher risk of addiction because of their past
history and medical comorbidities. This calls for special precaution. Better practice of screening
patients by carefully checking on history, providing good education to patients, family and
practitioners can help to avoid exposure and re-exposure to opioids. Because re-exposure can
lead people with positive history of addition to serious relapse and overdose. Even general

anesthesia using opioid during surgery can trigger it. Perhaps, in surgical patients, avoiding
opioid during surgery is one step away from these tragedies. Opioid free anesthesia was well
discussed and advocated by Dr. Barry Friedberg in his article reprinted in CASA Bulletin of
Anesthesiology 2019, originally published in Translational perioperative and Pain Medicine
2108;5(4).

In many cases, cutting down the prescription of opioids will not be enough. It probably
should be avoided in the first place. An interesting observation was made by a group of authors
who did a cohort study based on Veterans Health Administration veterans data. They reported
the overdose rates had increased among veterans from 2010 to 2016, although prescribed opioids
had declined. They concluded that this was because overdose on heroin and synthetic opioid

had increased at the same time in this these population. This study suggested that decreasing
opioid prescription alone, especially after previous use, may not help to control opioid addiction
and prevent overdose cross the board. The users apparently can turn to heroin and illicit opioids.
Therefore, broader preventive effort is needed. Like in all areas of health care, prevention is the
best strategy. The measures include a thorough and continuous education, alternative treatment
for pain, clinic-based as well as community-based addiction recovery program, medication-
assisted addiction treatment.

As rehab medicine doctor, we frequently see patients who have pain: back pain, joint pain,

myofascial pain/soft tissue strain and sprain, pain secondary to medical conditions such as spinal
cord injury, stroke, multiple sclerosis, brain injury, etc. Most cases are chronic, some cases are
still at acute stage. In my opinion, rehab should be considered and physical therapy should be
involved sooner than later once patient presents with acute pain. Physical therapy not only is an
effective treatment for pain, but it can also reduce chance of disability, maintain quality of life,
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