The surgeon’s dilemma.
An unescapable result of any invasive operation, certainly the chest surgery I performed for several decades, is pain. Patients hurt…a lot. My patients needed, actually required, narcotics/opioids (opioids are narcotics) for their pain. If the pain was insufficiently treated they not only suffered but were unable to breath sufficiently deeply to keep their lungs inflated. The steady lung collapse rendered them liable to a potentially fatal pneumonia. As they improved and resumed a diet I switched them from intravenous to oral opioids and maintained that regimen when they were discharged. As patients recovered and returned to be seen in my office I diminished the opioid dosage and added non-narcotics analgesics. When to stop the narcotics? That’s the dilemma. Two weeks? Too soon for most patients. Four weeks? OK for most but not all. I felt that six weeks was enough time for pain to have subsided sufficiently for the patient to switch completely to non-narcotic analgesics if any medication was needed. But there’s the rub. Pain is subjective and there is no way to objectively quantitate someone else’s sensation. When someone looks at you and says they are experiencing severe pain because you sliced through their skin and muscle and spread ribs apart, it’s hard to deny them.
My point is that opioids play an important role in our care of patients with extreme pain, whatever the cause. The answer to the crisis should not be to simply erase these drugs from the medical armamentarium. The answer has to lie in the willingness of surgeons to withhold opioids when the reported pain seems excessive, not to prescribe them for minor injuries, to cease their use when recovery from an operation or injury is complete and the government to crack down on physicians and pharmacies prescribing or selling inappropriately excessive amounts. It’s also useful to refer patient to credible pain management physicians when post-operative pain seems excessive in severity or longevity to a surgeon. They have and make use of many pain management strategies other than narcotics.
There are two sides to the issue and both must be appreciated for society to develop a rational strategy for the opioid crisis.
