Pain Management Policy

Pain Management

We practice a multimodal approach to pain management which typically includes regional anesthesia (interscalene block), intraoperative steroids, the strongest anti-inflammatory available, cold therapy, and opioid pain medicine which typically contains Tylenol as well.

Surgery Day

• Remember: Pain is part of the normal healing process after surgery.
• The pain will improve day-by-day.
• To get the work done we have cut through healthy tissue. Your body needs time to heal.
• The first few days are the worst. Things will continue to heal and improve the entire next year.
• The evidence is strong: the best pain reliever is peace of mind. The body goes through a natural healing process.
• Add ibuprofen 600 or 800 mg (3 or 4 over the counter pills) every 6 hours around the clock for two days—if you are allowed this medication. According to current best evidence, this is safe for your bones.
• Stagger the Tylenol and ibuprofen so that you're taking one or the other every three hours.
• Elevate the surgical area, but DO NOT take Tylenol with Percocet or other narcotics that have Tylenol (acetaminophen/APAP) as part of the medication
• Apply cold therapy, 40 out of every 60 minutes for the first few weeks as needed

Opioid Facts (Based American Academy of Orthopedic Surgeons Recommendations)

• The following medications are considered Opioids -- Codeine, Hydrocodone (ie, Vicodin, Norco), Oxycodone (ie, Percocet, Oxycontin), morphine, and hydromorphone (Dilaudid) are opioids.
• Opioids can relieve pain.
• Opioids are also addictive and can be deadly.
• Physical dependence to opioids (which means the absence of opioids can produce withdrawal symptoms) can occur at prescribed doses.
• Opioids are tightly controlled and monitored by the federal government through the Drug Enforcement Agency (DEA).
• The United States accounts for 80% of the opioid consumption in the world. Research consistently shows that Americans take more opioid medications and are less satisfied with pain relief after injury or surgery than patients with similar problems in other parts of the world. The leading cause of death among young adults in the United States is accidental poisoning. Overdose of prescription opioid pain medication and heroin accounts for 90% of these deaths. The prescription opioids that are causing these deaths have been traced to physician over-prescribing.

Research has shown:

1.There is wide variation in the amount of opioids prescribed by various providers.

2.Most patients take little or no opioids after minor procedures and wean off as quickly as possible after more substantial injuries and surgeries.

3.Continued opioid use is indicative of stress, distress, or less effective coping strategies.

4.Opioid strategies such as this one limit over-prescription and misuse of opioid pain medications and get patients the care they need and deserve.

Our Pain Management Policy

For our patients' wellbeing and because of ever tightening regulations and oversight, we have adopted the following strategy for the use of opioids to treat pain after surgery and injury. This strategy does not apply to patients that are dying from cancer.

Each patient receives opioid pain medications from a single provider.

For patients on suboxone or long-term opioids, their primary care or pain management doctor should be that single provider of Opioid prescriptions.

New patients with non-acute problems are not prescribed opioids.

We provide a set amount of opioids for pain after injury or surgery.

Orthopaedic surgeons do not give opioids for chronic pain.

Use of extended-release opioids for post-operative pain is generally discouraged.

Encourage the use of Tylenol or Ibuprofen instead of opioids.

Use as little opioid medication as possible.

Patients with more pain than expected will be encouraged to be evaluated in the office.