Recommendations for Non-Opioid Treatment Modalities

A news release from the Pennsylvania Medical Society summarizes a number of studies highlighting the prevalence of postsurgical opioid prescribing over the past 20 years, and the recent impetus for practice change prompted by the crisis of opioid abuse. Scott Shapiro, MD, president of the Society commented “Pretty clearly, opioids after surgery have become a routine of postoperative pain management. However, with worries rising about the addictive nature of certain pain relievers and pressure building to address an overreliance on such medications, the days of this type of prescribing are numbered.” The release outlines a number of patient and provider initiatives that are changing the perioperative experience in response to this situation.

Representatives from the Pennsylvania Orthopaedic Society describe the Enhanced Recovery After Surgery (ERAS) protocol, a multimodal treatment approach begun in pre-surgery to reduce pain, enhance recovery and limit opioid use. The protocol involves elements of diet and hydration pre-surgery, together with medications that include anti-inflammatories and a neuro-modulating block in addition to analgesics. Post-operative pain is sufficiently alleviated to permit ambulation in physical therapy within hours of surgery, and hospital discharge in 1 to 2 days. The Pennsylvania Medical Society has launched a patient empowerment program called “Opioids for Pain: Be Smart, Be Safe, Be Sure” that encourages patient questioning of, and involvement in, the prescribing decision. A news story, with links to further information, may be read here.


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