Doctors are advising alternatives to opioids
Hospitals manage pain with non-addictive medicines, therapies
After doctors at the Greater Baltimore Medical Center removed part of Dr. Alan Lake’s small and large intestines earlier this month, the retired pediatrician felt so little pain he didn’t need the powerful opioids most patients receive after major surgery.
Instead, doctors administered other, less addictive pain medication before and during the surgery as part of new “enhanced recovery” protocols being used by the hospital in colorectal surgeries to reduce recovery time and complications. Lake was given three non-addictive painkillers before his surgery to reduce pain and sensation in the intestine. Doctors also placed a nerve block in the surgery area during the procedure to more directly target the pain.
GBMC also no longer requires patients to fast or remain on bed rest for several days after these surgeries, and it also stopped giving them large amounts of IV fluids. The medical community now believes these once common surgical protocols cause more harm than once suspected.
The change in procedures is occurring as doctors face pressure to prescribe fewer opioids and other narcotics that can lead to addiction in some patients. Opioid addiction is fueling what’s become a nationwide heroin epidemic as addicts turn to the cheaper, more readily available street drug.
The Department of Health and Mental Hygiene announced earlier this month that it was instituting new rules for prescribing opioids to Medicaid patients that would force doctors to consider alternative painkillers, start with low doses and better screen patients for risk of abusing prescription drugs. The new rules also encourage doctors to refer more addicted patients to treatment.
The American College of Physicians this week announced new guidelines for treating lower back pain — one of the most common reasons for doctor visits — with therapies such as massage, spinal manipulation or acupuncture rather than drugs. If drugs are needed they should be antiinflammatory drugs or muscle relaxants, the group said.
“Physicians should consider opioids as a last option for treatment and only in patients who have failed other therapies, as they are associated with substantial harms, including the risk of addiction or accidental overdose,” said Dr. Nitin S. Damle, the group’s president, in a statement announcing the guidelines.
As doctors adopt the guidelines and hospitals establish new practices, many in the medical community hope alternative pain treatments like the protocol being used at GBMC become the norm.
“When you start talking about the problem with narcotics, it is huge,” said Dr. John J. Kuchar Jr., chairman of GBMC’s department of anesthesiology. “Although it can be good for short-term use, it is certainly not the panacea we all would have hoped it would be. You don’t want people walking around with a bag full of pills and getting addicted to them.”
Dr. Lake couldn’t agree more. The 70-year-old retiree from Glen Arm was back home within three days of his surgery and walking around his yard, to the surprise of his neighbors. He performed many surgeries during his career as a pediatric gastroenterologist and never expected recovery could be so easy. He said his pain threshold on a scale of 1 to 10 was a 2 after the surgery. The only painkiller he needed was Tylenol.
“Having the ability to use less narcotics and recover faster is all good as far as I’m concerned,” he said.
Enhanced recovery is one of the newest ways doctors are treating pain. Researchers are also looking at how regenerative medicine can treat pain. For instance, scientists are isolating platelets from blood and injecting them into joints. Platelets contain growth factors that promote healing, said Dr. Edward Soriano, who heads The Center for Pain Treatment and Regenerative Medicine at LifeBridge Health. Other researchers are injecting stem cells into various parts of the body in an effort to promote healing.
“There are so many non-narcotic treatments that can be used as a first response,” Soriano said. “Once people get on narcotics, getting them off becomes a much bigger challenge and issue.”
Other pain management alternatives have been used for years, such as nerve blocks, and prescription-strength Tylenol and ibuprofen. Doctors also say that