Q: I am scheduled for knee replacement surgery next month. I understand why doctors are reluctant to prescribe narcotics for post-operative pain, but I am worried my pain won’t be controlled. What therapies might work just as well?
A: Indeed, the opioid epidemic has prompted a change in course for many surgeons. Orthopedic surgeons had been the third highest prescriber of opioid analgesics in the United States. But all doctors, not just surgeons, are now increasingly turning toward non-opioid medications and other options to manage pain.
If you’re scheduled for a surgical procedure, having a plan to control pain after the surgery may help you avoid unnecessary use of opioids. It starts with having a conversation with your doctor prior to surgery.
Here are some strategies to help you find better and safer ways to manage your pain.
Take scheduled non-opioid pain relievers. Rather than waiting until the pain gets too severe before asking for medication, you can experience less pain by taking medication every 6 to 8 hours. Doctors often prescribe ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) on a regular schedule.
Limit opioid medication use. If it is necessary to use an opioid, take it only as needed in addition to your scheduled ibuprofen or acetaminophen. This way you will likely need lower doses of opioid to get pain relief. When you go home, you want to stop using opioids as soon as you can. Ideally, you should take it for less than a week — and only when other options won’t work.
Adjust your expectations. Your surgeon will probably reset your expectation. When people are having surgery, they should expect to have some pain or discomfort. While no one should have to endure excruciating pain, having some pain is okay. Knowing that it’s okay to have some pain can actually reduce the amount of pain medications required. Think of surgery like you would exercise: you’ll be sore afterward, but you wouldn’t take an opioid pain reliever to address the problem.
Use nonmedication strategies to manage pain. The key to effective pain management is to use a combination of methods. If you are having surgery on a lower extremity, elevate it after the procedure. This can help substantially with pain relief, swelling, and wound healing.
Icing the area can also help in the first 24 to 48 hours after surgery. But be certain to follow your doctor’s instructions carefully when using ice. It can cause tissue damage if used for too long — particularly in people who have reduced sensation in the area while the anesthetic used during surgery is wearing off.
Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.
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