woman speaking with her doctor

Why You Need to Advocate for Yourself and Create a Pain Management Treatment Plan Before Surgery

You may be taking opioids unnecessarily. A conversation with your doctors on your pain management options can help.

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Medically reviewed by Dr. Puja Shah

When Heidi Bright underwent a complete hysterectomy for uterine sarcoma in 2009, she was in the hospital for nine days. Striving to be the ideal patient who had the best odds of recovery, Bright did exactly what the doctors told her, which was to rely strictly on opioid painkillers to manage pain after the operation. Opioids are a class of drugs that includes the illegal drug heroin; synthetic versions such as fentanyl; and pain relievers available legally by prescription, such as oxycodone, hydrocodone, codeine, morphine, and many others.

"Being on painkillers was awful," said Bright, 60. "I felt really nauseous and was hallucinating."

Bright went on to have two more surgeries related to uterine sarcoma. Each time, the doctors prescribed opioids for her recovery, but they didn't discuss the side effects associated with them, which include confusion, constipation and nausea — to name but a few — nor did they mention that opioids are addictive and that some research shows women are more likely than men to continue to use opioids three to six months after surgery. Further, she does not recall anyone telling her that there may be opioid alternatives available to manage her pain and help lead to a quick recovery.

Over the years, Bright, now celebrating 10 years in remission from her diagnosis of uterine sarcoma, has learned the importance of advocating for herself and making a pain management plan for after surgery before any procedure. Doing this allows her to not only minimize the use of opioids, but also recover more comfortably and get back to her normal life quickly without feeling miserable.

Women have a million reasons why they need to heal quickly

A swift and smooth recovery after surgery is critical for anyone, but it's especially crucial for women, who are likely to be managing numerous responsibilities.

"All the women I know are juggling career, motherhood or soon-to-be motherhood, along with balance within their normal lives around staying fit and healthy," said Dr. Puja Shah, an anesthesiologist and interventional pain management specialist. "Early recovery is extremely important for women, especially if other people are relying on them, whether they're a professional or a mother or playing some other familial role. They also need to step back into the mindset of their authentic selves so that they can get better and get back to their lives."

While there is a time and place for opioids, they should not be viewed as a standalone option for pain management. There are effective non-opioid options available to help manage pain and minimize opioid use following surgery while providing patients with an optimal overall recovery experience.

ERAS may eliminate the need for opioids post-op

If you're undergoing a c-section, mastectomy, hysterectomy, breast reconstruction surgery or any other major procedure, you should talk to your healthcare providers about enhanced recovery after surgery protocols (ERAS). ERAS involves the use of medications that may include opioids but aim to lessen the amount needed. When appropriate, ERAS may eliminate the need for opioid use after surgery altogether by using effective non-opioid options.

"ERAS means we use a variety of different medications to target different receptors, as opposed to just using opioids," Shah said. For example, you could use a mixture of anti-inflammatory drugs like ibuprofen, acetaminophen and long-acting local anesthetics that can be used to locally numb an area of your body where you have had surgery

Essentially, ERAS is a method of "attacking the pain from many different angles," Dr. Sachin Jha, an anesthesiologist, explained.

For example, including a long-acting numbing medication as part of an ERAS protocol can play a critical role in recovery. This helps provide pain relief for patients in the first few days following surgery, when pain is often at its peak, by releasing a numbing medication into the body over time.

You get to be a voice in what your recovery will look like

The good news is that you have a voice as a patient and can be your own advocate for ERAS. You should discuss with your doctor whether you want opioids involved in your pain management plan, and if so, to what extent. You can also ask if there are non-opioid options available to help manage your pain.

To make a plan for your fastest and safest recovery, you need to have a detailed conversation with your healthcare providers. Ideally, you'll want to have this discussion as soon as you're booked for surgery.

Here's what both Shah and Jha recommend asking your surgeon, anesthesiologist and pain management specialist, if available.

  • How much discomfort is usually associated with this procedure?
  • How can I minimize the need for opioids? What non-opioid options do I have?
  • How can I best recover?
  • What is going to be expected of me during my recovery?
  • What are the best- and worst-case scenarios for my recovery?

If both you and your healthcare team deem it appropriate to avoid opioids, you may experience a faster recovery because the side effects of opioids can cause delay and complications.

"If, for instance, you can't walk around on your brand-new knee because you're too sedated from opioids, then you can't rehab effectively, and that alone will put you at risk for longer-term complications," Jha said. "It's so imperative that you rehab very effectively. Once you get complications, things go downhill very quickly. They also can get very expensive."

Shah added that minimizing opioids can also help factor in your overall plan of nutrition, hydration and mobility, all of which are helpful in recovery. Your mental health also stands to fare well by minimizing opioids.

This resource has been created with support from Pacira BioSciences, Inc.

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