Opioid-free surgery treats pain on all physical and emotional levels

The Opioid crisis stays a serious public health challenge within the United States. In 2022 over 2.5 million American adults had opioid use disorder and opioids were responsible Nearly 76% of overdose deaths.

Some patients are Fear of using opioids after surgery as a result of concerns about dependency and possible unintended effects, even when appropriately prescribed by a health care provider for pain management. Surgery is usually the primary time patients receive an opioid prescription, and their widespread use raises concerns that patients could turn out to be long-term users. Leftover pills Medicines from patient prescriptions can be misused.

Researcher like us are working to develop a personalised and comprehensive surgical experience that doesn’t involve using opioids. Our approach to opioid-free surgery targets each physical and emotional well-being through effective anesthesia and complementary pain management techniques.

What is opioid-free anesthesia?

Doctors have used morphine and other opioids to treat pain Thousands of years. These medications remain a necessary a part of anesthesia.

Most surgical procedures use a technique called balanced anesthesiathat mixes drugs that stimulate sleep and chill out muscles with opioids to combat pain. However, using opioids in anesthesia could also be possible result in undesirable unintended effectsresembling severe heart and respiration problems, nausea and vomiting, and digestive problems.

Concern about these adversarial effects and the opioid crisis have spurred the event of Opioid-free anesthesia. This approach uses non-opioid medications to alleviate pain before, during, and after surgery while minimizing the danger of unintended effects and dependence. Studies have shown that opioid-free anesthesia may also help comparable pain relief to traditional methods with opioids.

Opioid-free anesthesia is currently based on a multimodal approach. This signifies that the treatments goal different pain receptors beyond the opioid receptors within the spinal cord. Multimodal analgesia uses a mix of at the very least two medications or anesthetic techniques, each of which uses different mechanisms to alleviate pain. The aim is to effectively block or modulate pain signals from the brain, spinal cord and nerves of the body.

For example, nonsteroidal anti-inflammatory drugs, or NSAIDs, resembling ibuprofen, work by inhibition COX enzymes which promote inflammation. Acetaminophen or Tylenol similarly inhibits COX enzymes. While each acetaminophen and NSAIDs primarily goal pain on the surgical site, they can even affect the spine after several days of use.

A category of medicine called Gabapentinoidswhich include gabapentin and pregabalin, goal certain proteins to dampen nerve signaling. This relieves neuropathic pain by reducing nerve inflammation.

The anesthetic Ketamine disrupts the pain pathways that contribute to a so-called condition central sensitization. This disorder occurs when nerve cells within the spinal cord and brain amplify pain signals even after the unique injury or source of pain has healed. As a result, normal sensations resembling light touch or light pressure could also be experienced as painful, and painful stimuli may feel more intense than usual. Ketamine may also help by reducing pain sensitivity Reduce the danger of chronic pain.

Regional anesthesia Local anesthetics are injected near nerves to dam pain signals to the brain. This method allows patients to stay awake but pain-free within the anesthetized area, reducing the necessity for general anesthesia and its unintended effects. Common regional techniques include epidurals, spinal anesthesia, and nerve blocks.

By concurrently activating different pain pathways, multimodal approaches aim to synergistically improve pain relief.

Psychology of pain perception

Psychological aspects can significantly influence a patient's perception of pain. Research suggests this mental illnesses resembling anxiety, depression and sleep disorders can occur increase pain levels by as much as 50%. This suggests that addressing mood and sleep problems could also be critical to managing pain and improving the patient's overall well-being.

Psychological conditions can significantly increase the perception of pain Influencing the nerve pathways related to pain processing. For example, fear and stress activate the body's fight or flight response and cause the discharge of stress hormones that increase nerve sensitivity. This could make the pain feel more intense. Research has also found this higher levels of hysteria before surgery are related to increased anesthesia use during surgery and opioid consumption after surgery.

Complementary and alternative techniques that address psychological aspects may reduce pain and opioid use by modulating pain transmission within the nervous system and activating neurochemical pathways that promote pain relief.

For example, aromatherapy uses essential oils to stimulate the olfactory system. This may also help reduce pain perception and improve overall well-being by evoking emotional responses and promoting leisure.

Music therapy stimulates the hearing system, which may distract patients from pain, reduce anxiety levels and promote emotional healing. This can ultimately result in reduced pain perception.

Relaxation exercisesSuch as deep respiration and progressive muscle leisure, activate the parasympathetic nervous system and help promote a state of calm. Activating the parasympathetic nervous system helps the body conserve energy, slow the guts rate, lower blood pressure, and relieve muscle tension. This can result in reduced pain sensitivity and promote a state of calm.

acupuncture Thin needles are inserted into specific points on the body, stimulating the discharge of endorphins and other neurotransmitters. These molecules can interrupt pain signals and promote healing processes within the body.

Towards opioid-free surgery

Moving away from opioids in surgery requires a shift in each practice and mindset across the healthcare team. In addition to anesthesiologists, there are other providers including surgeons, nurses, and medical trainees. also use opioids in patient care. All providers would should be open to the use of different pain management techniques throughout the surgical process.

In response to increasing patient demand for opioid-free surgical care, our team on the University of Pittsburgh Medical Center created this Patient-initiated opioid-free surgical pain management program in May 2024. To address each the physical and emotional dimensions of pain while optimizing recovery and safety, we recruited surgeons, anesthesiologists, nurses, pharmacists and hospital administrators to take part in the initiative.

Over the course of six monthsOur team recruited 109 patients, 79 of whom underwent successful surgery without opioids. Barriers to participation in this system included patient perception of severe pain, inadequate management of stress and anxiety prior to surgery, and inadequate departmental education concerning the program.

However, later refinements to this system—resembling giving patients muscle relaxants during recovery from anesthesia—improved participation and reduced opioid use. Importantly, not one of the 19 patients who received opioids while recovering within the hospital after surgery required additional opioid prescriptions at discharge.

These results reflect the promise of our journey to attenuate dependence on opioids while ensuring effective pain management. Improved psychological support for patients and education for providers in surgical departments may increase the effectiveness of a comprehensive approach to pain management.