The following is a guest blog post by Alan M Reznik, MD, MBA, a member of the American Academy of Orthopedic Surgeons Communications Cabinet and the liaison to the AAOS Patient Safety Committee. He is a sports medicine specialist focusing on knee and shoulder injuries, practicing in the greater New Haven area, and Chief Medical Officer of Connecticut Orthopedic Specialist.
Feeling pain makes you pull your hand off a hot pot before a bad burn or come in from the cold to prevent frostbite. It also tells you when you have a cut, broken bone or eaten something you should have not eaten. We never forget these events because they “hurt!” Your body is very smart and ‘Mother Nature’ has created the nerves that “feel” pain. These special nerves are called ‘pain fibers.’ The real answer is PAIN is the way your brain understands the signals from those nerves. Your brain then stores these memories to stop you from repeating a painful event. So there is always a reason for pain every time you experience it. There is an old joke and it’s true, “It hurts when I do that.” And your doctor says, “So don’t do it.”
Pain has many benefits. It helps the body release special chemicals that are needed for healthy healing. Pain also tells us when we are overdoing it. In addition, pain is an early warning system for most medical complications. Using too much pain medication can override Mother Nature’s messages. Therefore masking pain completely with a drug is never ideal. It can lead to failure of fracture repair, increased swelling, delayed healing and missed complications.
When injured, pain should be addressed by first fixing the reason for the pain: cast the fracture, stitch the cut, fix the bone or start an antibiotic. Then we can use treatments to decrease pain at the source like anti-inflammatories for inflammation, elevation and ice for swelling. Narcotics are never the only treatment for pain. Medications should never mask pain so completely that your own body’s ways of helping you heal cannot work properly. A dog never walks on a broken paw until it stops hurting. Only people take possibly addicting medications so they can walk, run, work or drive while having a painful limb.
Still, after an injury or surgery, pain medications are often prescribed. Pain medication can help get people moving after an injury and movement has great benefits. Therefore, we don’t want to have too much pain and at the same time no one wants their doctor to miss the early signs of a preventable complication because of too much medication.
Anxiety, stress, fear, muscle spasm, swelling and not resting or elevating an injured body part can all worsen pain. Fortunately, stress, anxiety and muscle spasm can be treated with non-narcotic medications. For each problem, the full choice of treatments should be considered before increasing or continuing a narcotic in place of solving the real problem.
Whether the patient is an adult or a child, having family or friends become part of the team to deal with pain from an injury or surgery is important. Bring someone along to make the plan with your doctor, and to help stick to the plan once you are home.”
As doctors, our goal is to help ‘Mother Nature’ do her job, not help our patients hurt themselves more. Always choose appropriate treatments over narcotic pain medicine as a first choice and help us stop the National Narcotic Addition Epidemic! We can only do it together.
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Here are some examples of so called “Opioid” or “narcotic” pain medications:
Morphine, Vicodin (Hydrocodone), Percocet (oxycodone), Codeine, Oxycontin, Dilaudid, Tylenol with codeine and others. Approximately 100 people die in the US per day from overdoses. Not starting these medications when they are not the first choice for a problem is our first step to saving these lives. The USA uses the majority of the world’s oral Narcotic (opioid) medications and we are 5% of the world’s population.
