Dr. Jonah Stolberg
Assistant Professor, Surgery at Northwestern Medicine and Member of the Opioid Reduction Task Force, American College of Surgeons
“Over the last 20 years, there’s been an increased focus on patient satisfaction and pain control,” says Dr. Jonah Stolberg, assistant professor of surgery at Northwestern Medicine, who is also on the opioid reduction task force for the American College of Surgeons.
This focus on pain elimination was dangerous. Many patients became addicted to opioids, which were cheap to get and easy to take. The risks of taking opioids were downplayed. These factors combined led to a culture where patients expect to be relatively pain-free around the time of surgery.
Resetting expectations
Dr. Stolberg, a funded independent researcher with National Institute on Drug Abuse and the director of opioid reduction practices for the Illinois Surgical Quality Improvement Collaborative, says now is the time to reset expectations both for patients and providers.
“The hardest thing that we need to overcome is this culture that’s built up around the elimination of pain,” he says.
Dr. Stolberg says 80 to 85 percent of patients are prescribed an opioid prescription following a procedure. According to Dr. Stolberg, this is the wrong approach. Instead, it is important that patients start with drugs that have the lowest risk of addiction, such as acetaminophen or ibuprofen. Then, additional medications can be introduced as needed. Patients should also use ice and stretching techniques within the first 48 hours following surgery. Heat can be applied 3-5 days after surgery.
A positive outlook
“Pain needs to be adequately treated but not eliminated,” Dr. Stolberg says, encouraging patients to talk with their doctor about pain management before their surgery.
When opioid prescriptions are written, doctors should prescribe smaller amounts, such as 15 pills instead of 30.
Dr. Solberg is hopeful about the future. He says some promising non-opioid pain products in clinical trials may offer prolonged pain management for 3-5 days of pain control in the incision area. Plus, the healthcare community may start adjusting their pain management practices.
“If we can make that cultural shift, [it] will fundamentally do a lot of good for society,” he says.