Striking a balance: Handling pain after surgery when you’re already on opioid pain relievers

It makes perfect sense: People with chronic pain want to feel better. But it’s not always easy to get long-term pain under control. For one thing, it can take time to find a health care provider to work with you to manage your pain. And it also takes time to discover which things work the best, with the least side effects.

If you’ve been through this type of challenge, and your pain is finally under control with the help of an opioid medication, then there’s nothing more to think about… right?

Unfortunately, that may not be the case if you’re going to have surgery. Let’s see why.

Tolerance

People who take prescription pain medications, such as opioids for chronic pain, sometimes become tolerant to these medications. Tolerance to a medication means that your body has “gotten used” to having that drug in your system. As a result, the original dose may not continue to work as well as it used to as time goes by. Your health care provider may then prescribe a higher dose, so you can get the same pain-relieving effects that you had before. In some cases, your health care provider might switch you to another medication.

In some cases, though, this careful planning to get chronic pain under control may “go out the window” – especially if you’ve been taking opioids for a long time, need surgery, and have developed a tolerance to opioid medication. Problems can arise if your surgical team isn’t comfortable with – or used to – giving higher-than-usual doses of opioids to control pain after an operation.

Myths about using opioids to treat pain after surgery

  • Patients who are on opioids before surgery already have enough protection against any pain that follows surgery. This belief is generally wrong! You may need more medication to control your pain after surgery.
  • Anyone on opioids for chronic pain needs to stop taking these medications before surgery.Some health care providers wrongly feel that opioids should immediately be stopped, even if the reason they are being taken still exists.
  • Everyone who takes opioid pain relievers becomes addicted to the medications, so patients shouldn’t get any extra opioids for their pain after surgery. This is wrong as well! While it varies, not everyone becomes addicted.
  • All pain during recovery from surgery can be managed with one medication. This is wrong too! The right solution may actually be a number of medications combined to minimize side effects, and have them work together to control the pain.

The truth about opioids and surgery

Pain experts know that these myths can cause big problems for patients who need surgery, especially if any of these patients has become tolerant to opioids.

Here are the facts:

  • People who show a tolerance to opioids before surgery may actually need higher doses of these drugs after surgery than people who haven’t been taking prescription opioids. In fact, some of these patients may need 2-3 times their normal daily opioid dose for proper pain control.
  • Stopping or lowering chronic pain medication before surgery can make it harder to control pain after the operation.
  • Health care providers can also prescribe other pain medications after surgery, along with opioids. This approach lets you use lower levels of opioids to control pain.

What can you do?

Make sure that everyone is on the same page.

  • Your health care team needs to know the names and dosages of all the prescription and over-the-counter medications that you’re taking.
  • Describe how any flare-ups of your pain are usually handled and which pain-control methods work best for you.
  • Don’t forget to mention any pain medicines that haven’t worked for you in the past, too.

Your health care team can use all of this information to choose the best pain medicine for you after your operation. When pain after surgery is discussed with you beforehand, your fear of the unknown should disappear, and you’ll do better.

You have a right to proper pain control after surgery and communication is your best tool: Speak with your health care providers in advance to make sure that your pain is under control.

References

Postoperative pain management for the opioid-tolerant patient
Burgess FW, Maslow A. (2008). Medicine & Health/Rhode Island: 91(9):pp 276-278
http://www.rimed.org/medhealthri/archived/m08Septmhri.pdfPost-surgical pain
http://www.surgeryencyclopedia.com/Pa-St/Post-Surgical-Pain.html
(Scroll down to section on “Opioid-tolerant patients”)