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A non-opioid way to relieve pain after knee and shoulder surgery

News Photo: A non-opioid way to relieve pain after knee and shoulder surgery

MONDAY, February 14, 2022 (HealthDay News)

Two new pain relief studies suggest there is a safer alternative to addictive opioid painkillers after knee and shoulder surgery.

Findings consistent with changes to volunteering federal guidelines for the prescription of opioid painkillers offered by the US Centers for Disease Control and Prevention last week. The proposal urges doctors to prescribe non-opioid therapies whenever possible.

“These studies demonstrated that an alternative non-opioid pain treatment was equally effective in managing postoperative pain after ACL and rotator cuff surgery compared to traditional opioid medications,” said Dr Kelechi. Okoroha, lead author of both studies. He is an orthopedic surgeon at the Center for Orthopedics and Sports Medicine at the Mayo Clinic in Minneapolis.

In a study62 patients underwent knee surgery to reconstruct their anterior cruciate ligament (ACL), and the second study included 40 people who had surgery to repair the rotator cuff in their shoulders.

Everyone received a nerve block before surgery. In both studies, one group received an opioid for pain, while the other received nonopioid pain relievers such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and/or medications targeting nerve pain.

Both studies found that the non-opioid diet provided as much – if not more – pain control and satisfaction than opioids for the first 10 days after surgery.

Different drugs target different types of pain, Okoroha said.

“Acetaminophen and NSAIDs are used to target the pain cascade and postoperative inflammation, respectively,” he said. “Gabapentin is used to treat nerve pain and methocarbamol [Robaxin] can control muscle cramps and spasms.”

This strategy eliminates the use of opioids, which are very addictive and led to nationwide action overdose epidemic. Orthopedic and spine conditions account for about 3 in 10 opioid prescriptions, Okoroha said.

The new approach may also help people having other types of surgery avoid opioids and their risks, he said.

“The regimen has been shown to be effective in common sports surgeries, but could be extended to a wider range of procedures,” Okoroha said.

In both studies, the most common side effects were drowsiness, dizziness and gastrointestinal symptoms. In the shoulder study, participants who received the opioid-free regimen reported fewer side effects than those who took opioids.

Two outside experts welcomed the findings.

“The opioid epidemic still exists, and some people become addicted after postoperative opioid use,” said Dr. Adam Yanke, orthopedic surgeon at Rush University Medical Center in Chicago.

He pointed out that opioids aren’t all bad, though. They can be very effective in reducing pain when given in small doses after major surgeries.

“Both studies certainly demonstrate that, at least initially, many patients can be opioid-free after surgery,” Yanke said, adding that this approach could also help people get back on their feet faster. Many now go home the same day of their joint replacement surgery, so it is important to provide them with pain relief that will not cause them to feel dizzy or fall.

The new approach significantly reduces the side effects and risks associated with opioids, agreed Dr. Faye Rim, physiatrist and pain management specialist at the Hospital for Special Surgery in New York.




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“While there are more drugs to take with this approach compared to an opioid, there may be fewer side effects such as constipation, nausea and excessive sedation, and there is less concern for addiction or withdrawal symptoms when stopping these drugs as well,” she said.

This diet could work for any painful procedure, Rim said.

“Patients need to agree and recognize the risks and benefits of an opioid-free protocol, and have realistic expectations for the postoperative period,” she added.

The shoulder surgery study was published recently in Arthroscopy: the journal of arthroscopic and related surgeryand ACL surgery has been detailed in The American Journal of Sports Medicine.

More information

The US Department of Health and Human Services provides more information on alternatives to opioids for pain relief.

SOURCES: Kelechi Okoroha, MD, orthopedic surgeon and sports medicine specialist, Mayo Clinic, Minneapolis; Adam Yanke MD, PhD, orthopedic sports medicine surgeon, associate director, Cartilage Restoration Center, Rush University Medical Center, Chicago; Faye Rim, MD, physiatrist, pain management specialist, Hospital for Special Surgery, New York; Arthroscopy: the journal of arthroscopic and related surgeryNovember 25, 2021; The American Journal of Sports MedicineDecember 1, 2021

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