Q&A with Dr. Elizabeth Cherot

According to a new national report, post-surgical opioids continue to be overprescribed. On average, patients receive 82 opioid pills to help manage pain after surgery. Having large amounts of leftover opioids after surgery is dangerous for patients, their families, and their communities.

One way to reduce opioid overprescribing is to ensure that patients are educated about pain management options before surgery, and that they feel empowered to ask their doctors about opioid alternatives. This is especially important for expecting mothers, as research shows postsurgical opioids pose a particularly dangerous risk to women.¹

Dr. Elizabeth Cherot, a physician at Brunswick Hills OB/GYN, an Axia Women's Health Care Center, is keenly aware of the opioid epidemic and is working to encourage patients to seek non-opioid options for managing pain after surgery. As a practicing OB/GYN, she uses non-opioid options within her practice to help women recover quickly, and to reduce, or in some cases eliminate, the need for opioids following many common procedures, including Cesarean section (C-section).

 In this interview, Dr. Cherot shared useful information about managing pain after surgery and discussed important tips to help women navigate a pain management conversation with their surgeon.

There’s been news that women outpace men in their use of opioids. Is that true, and does that put women at a greater risk for opioid misuse?

Yes, that is true. Research shows that women are often prescribed more opioids than men. This disparity may be due to the higher prevalence of chronic disease and pain conditions among women that are often treated with opioids. In addition to receiving more opioids, women are 40 percent more likely than men to become newly persistent opioid users following surgery² — meaning they continued to take opioids three to six months following surgery.

Given these risks, it’s important that women are educated about their options to manage pain after surgery — including non-opioids.

Women may face several different gender-specific surgeries throughout their lifetime, potentially including C-section(s), breast reconstruction and hysterectomy. Are opioids commonly prescribed to manage pain after these procedures?

While opioids have long been used as the first-line of treatment for pain after surgeries like C-sections, breast reconstruction and hysterectomies, we’re fortunate that effective alternatives are now available to help patients manage pain. I am confident the surgical space is an area where we can significantly reduce the number of opioids prescribed, and for some procedures completely eliminate them, all while providing our patients with faster and more positive recovery experiences. Patients and their caregivers should always feel empowered to ask how they can manage their pain with non-opioid options prior to having surgery.

Is childbirth the first time women are exposed to opioids?

Childbirth may be the first time a woman is exposed to opioids or other types of pain medication. Women who deliver vaginally, and do not have any complications, often don’t require opioids. However, women undergoing C-sections — a major surgery — should expect to have some level of discomfort after the procedure.

Although more than half of women undergoing a C-section are prescribed opioids³, there are effective non-opioid options available that can help new moms get through the first couple days after surgery with minimal pain, and without the common side effects of opioids such as dizziness, nausea and constipation. In my practice, we offer every single C-section patient — 100 percent of the time — a non-opioid pain management option. As a result, their recovery experience is remarkably better, so they can enjoy that time with their new family.

How has the opioid epidemic affected your area of medicine and your prescribing habits?

The impact of the opioid crisis in this country is alarming and I think it’s taken the entire medical community by storm. As a result, several clinicians have incorporated non-opioid options in their respective practices, thereby reducing the need for opioids. These new options are equally effective at managing pain, and they don’t carry the risk of addiction or dependence.

In my practice, we have an enhanced recovery program that educates women ahead of time on their pain management options during and after their C-sections. In fact, we have developed an entire protocol that has benefitted our patients in multiple ways. We discuss options in the office before surgery and develop a plan of care. We then continue the discussion throughout the post-operative process and work to reduce or avoid opioid use. This approach has been very successful. In fact, within the last year alone, I have had over 100 patients use a non-opioid protocol for postsurgical pain relief, which includes a long-acting numbing medication used during surgery. This approach allows patients to safely heal, ambulate more quickly, and avoid side effects associated with opioids.

What side effects may occur if women use opioids to manage their postsurgical pain?

There are several side effects⁴ to opioids that could impact a mother’s comfort and ability to care for her baby following childbirth. C-section patients are especially prone to constipation,⁵ as opioids slow down the intestinal track, potentially putting additional strain on a new mother’s body. Other common side effects⁶, including nausea, vomiting, confusion, dizziness and drowsiness, may inhibit a mother from fully experiencing the first few days of her new baby’s life.

While expectant mothers should not feel they need to completely avoid opioids if medically necessary, it’s important that patients and doctors discuss utilizing the lowest dose for the shortest amount of time.

Do you find that expectant mothers are comfortable talking about pain management options or the creation of a pain management plan?

Although women should feel empowered to ask their doctor about the creation of a pain management plan and the treatment options available, that does not always happen. In fact, a recent survey found that nearly nine in 10 mothers and mothers-to-be have concerns about taking opioids during and after childbirth, but only 11 percent said they discussed non-opioid pain management options with their physician before delivering their baby.⁷

That’s why it’s important for patients to have an open dialogue with their doctor about their postsurgical pain management, and proactively ask about non-opioid options if the doctor doesn’t bring it up prior to surgery.

What aspects of pain management should patients discuss with their surgeons?

Pain is different for everyone, so women should feel empowered to discuss all aspects of pain management before a surgical procedure. Some useful talking points to keep in mind include a patient’s pain tolerance, any concerns about pain medications and opioids, availability of opioid alternatives, family or personal history of substance use disorder, level of caregiver support, and expectations during recovery.

Are non-opioid options available for other surgical procedures?

Fortunately, yes. Non-opioid options are available for most surgeries, including knee replacement, hip replacement, gallbladder removal, oral surgery, weight loss surgery and more. Patients can educate themselves on their choices for pain management by leveraging helpful resources, such as shatterproof.org/choices-matter, prior to surgery.

Originally published in 2018.