Preparing for Proper Pain Management

The opioid epidemic has affected Americans of all races, ages, locations, and socioeconomic backgrounds. However, some studies show that some groups may be more commonly exposed to opioids than others, putting them at increased risk for dependence or addiction. In fact, women ages 40-59 are prescribed more opioids than any other age group and receive twice as many opioid prescriptions as their male counterparts. One explanation for this could be the many different gender-specific surgeries that could occur throughout a women’s lifetime, ranging from C-sections to hysterectomies to breast reconstructions.

Whether a surgery is elective or medically necessary, it’s important to have a conversation with your doctor about all available pain management options, including non-opioids. These conversations are especially critical in light of research demonstrating that women are particularly vulnerable when prescribed opioids after surgery. In fact, women are 40% more likely than men to become persistent opioid users following surgery, meaning they are still taking opioids three to six months following their procedure.

We recently spoke with Dr. Lisa Hunsicker, a board-certified plastic surgeon at Revalla Plastic Surgery & Medical Aesthetics in Colorado, about her commitment to reduce opioid use among her breast cancer patients by implementing a novel approach to breast reconstruction that utilizes non-opioid options and enhances the recovery experience for her patients.

Tell us more about your approach to breast reconstruction and how it has helped your breast cancer patients.

One of the more intensive and painful surgeries I perform on women is a direct-to-implant breast reconstruction. Direct-to-implant breast reconstruction surgeries are performed at the time of a mastectomy (a surgical operation to remove the breast) and requires a general surgeon (who performs the mastectomy) and the plastic surgeon (who performs the breast reconstruction) that work in tandem as part of the same procedure. Because there are multiple people involved in this process, it’s especially important for all of us to be aligned on the pain management approach for our patient. Our approach includes the utilization of non-opioid options before, during and after surgery. Through this approach, we are able to significantly decrease, or in some cases, completely eliminate the need for opioids with our patients. This not only helps them avoid the unwanted side effects of these medications (such as nausea, vomiting, dizziness, etc.), but allows them to have a better recovery experience with minimal pain.

One of the greatest benefits of direct-to-implant breast reconstruction is that it doesn’t require multiple surgeries. In contrast to the traditional approach to implant-based reconstruction, which requires multiple procedures to complete the reconstructive process, direct-to-implant patients most commonly have their breast reconstruction completed in one surgery, which minimizes the overall recovery time for the patient. In fact, this surgery is typically done outpatient now, meaning they don’t have to stay over at the hospital.

Why do you think your patients are driven to get home and recover quickly after surgery?

Women are often juggling several aspects of life simultaneously, from tackling a job, running a household, supporting friends, and caring for loved ones. A new survey which polled 500 women aged 30-50 found that 96% are motivated to get back to their daily routine following surgery, with more than 40% citing caregiving responsibilities and more than 30% saying a quick return to work are the main drivers to quickly recover. Despite these findings, the survey also found that while women address several topics with doctors prior to surgery, many are missing a crucial discussion that could help them achieve a rapid recovery — a conversation about non-opioid pain management options. Ensuring the most effective pain management strategy is in place can really make a difference in how a person recovers and gets back to day-to-day activities after surgery.

Opioids have been used to manage pain after surgery for many years. Why did you decide to take a different approach?

Surgery is often the first time a person is exposed to opioids. In fact, the survey found that 67% of women took an opioid following their surgery even though 84% had concerns about being prescribed or taking opioids. The truth is opioids continue to be overprescribed in the surgical setting which has created an unintentional gateway to opioid dependence and addiction. For patients who may be concerned about the risks of taking opioids or have a connection to opioid use disorder and want to avoid these medications, it is important that they know there are other options available.

And, as a surgeon caring for vulnerable patients, I knew we could do better. Utilizing non-opioid options helps to reduce several risks and can reduce the number of individuals whose lives are affected by substance use disorder. Unfortunately, many patients may not be aware that they have other options to manage pain effectively. It’s clear that clinicians like myself have an important role in educating our patients about the non-opioid options available.

What type of non-opioid pain management options do you use? And what are the benefits?

For my patients, I utilize a long-acting numbing medication injected during surgery to help manage pain after surgery. This non-opioid option can last for the first few days after surgery when pain is often the worst. This approach has also enabled me to reduce the number of opioids I prescribe, as most patients only need over-the-counter medications to manage their pain. Limiting opioid use also reduces the risk of unpleasant side effects such as nausea, vomiting, constipation, and confusion.

I encourage you to talk to your doctor about pain management options, including non-opioids, prior to surgery. You might find that a non-opioid option is available to help you manage pain with limited or no exposure to opioids.

What’s the best way for patients to discuss these options with their doctor?

Pain is personal, and everyone experiences it differently. That is why I encourage an open dialogue about pain management with my patients before surgery. For anyone who may be preparing for surgery, or anticipating a surgery in the future, there are helpful discussion guides available to facilitate these conversations. These resources provide an overview on what topics to discuss ranging from how you typically tolerate pain to how your caregiver should be planned to support you during your recovery.