We are currently living in an opioid crisis in the United States. Approximately 180 Americans die every day from an opioid overdose. More than 500,000 people have died during the past decade as a result. More families have been affected by addiction, overdose, and death from opioids than ever before. Opioid overdose is now one of the leading causes of death in young adults. Unfortunately, the problem has continued to escalate since the COVID-19 pandemic began.
Opioids are a group of drugs which are derived from the poppy plant, the same plant which is used to make opium, heroin and morphine. Opioids are powerful “pain killer” medications commonly prescribed to treat pain after an injury or surgery. They include oxycodone, hydrocodone, codeine, and fentanyl. An unintended consequence of using this medication is opioid addiction, which can happen to anyone. Less severe side effects include allergic reactions, nausea, vomiting, constipation, itching, dizziness, headaches, and sedation.
There are many methods to achieve pain relief after an injury or surgery. Consider these non-opioid strategies first to minimize the need for opioids after hand surgery:
- Rest the hand: Reduce hand activity and take rest breaks
- Elevate the hand: Elevate the hand to the level of the heart to reduce swelling and pain
- Use ice: Apply cold packs to the affected area for 10-20 minutes at a time several times per day
- NSAIDs: Use non-steroidal anti-inflammatory drugs (NSAIDs) such as oral ibuprofen or naproxen to reduce swelling and pain
- Tylenol: Oral acetaminophen can be used in addition to NSAIDs to reduce pain
- Reduce stress/anxiety: High levels of stress and anxiety increase the intensity of pain symptoms.
If these measures do not control the pain, or if the pain is severe, it is reasonable to take a prescribed opioid medication for a brief period of time. In order to minimize the risks of opioids, there are several important guidelines to follow:
- Only take the medication as prescribed by your doctor
- Do not take medication prescribed to another person
- Take the least amount of medication possible
- Stop taking the medications when the pain subsides
- Notify your doctor if you are developing a reaction to the medication
- Avoid using alcohol or other sedatives when taking opioids
- Dispose of all unused medication properly; many teenagers and young adults have access to opioid medications in the medicine cabinet at home
- Keep medication safely stored away from children and teenagers in the household
Remember that after an injury or surgery, the body needs time to rest and heal. Pain is a normal response to an injury to the body. It is not possible for medications to take away all the pain, but the goal is to make the pain more tolerable. For most patients, the first 2-3 days after surgery are the most painful, and then the pain gradually subsides.
Hand surgeons often use long-acting numbing medications to make the day of surgery more tolerable for their patients. It is usually recommended to start taking NSAIDs and Tylenol before the numbing medicine fully wears off in order to “stay ahead of the pain.”
Many patients can avoid opioids after surgery if they use both NSAIDs and Tylenol together. These medications are synergistic, meaning they work better when combined than when either is used alone. A common adult dosing schedule involves taking 600 mg of Ibuprofen, then 4 hours later taking 650 mg of Tylenol, then 4 hours later taking Ibuprofen, etc, alternating these medications for the first 2 days. These medications can be purchased over the counter. However, patients with kidney disease, liver problems, stomach ulcers, intestinal bleeding, and patients taking blood thinners should consult with their doctor prior to using these medications. Patients should avoid taking more than 4000 mg of Tylenol in a 24 hour period.
If someone has an opioid use disorder or addiction, it is very difficult to recover. The relapse rate is very high. Encourage loved ones to get treatment at a high quality treatment center for the best outcome.