introduce many patients to opioids and prescribe the vast majority of
unused opioids.
Counseling patients
Prescribing recommendations provide a framework for how many
pills patients should receive after surgery, but efforts to right-size
post-op opioid use should also include communicating with patients.
• Set realistic expectations. Surgery will hurt. Patients need to
understand that eliminating post-op pain entirely is both unrealistic
and inappropriate. Tell them that some pain is normal, but they should
be able to walk and perform light activities during the first few days
of recovery. Let them know that their pain will gradually dissipate.
• Share norms. Inform patients that the recommended pill amounts
are based on scores of patient-reported data and that many patients
claim they need only up to 5 pills to adequately manage their pain.
• Tout non-opioid options. Advise patients to take acetaminophen
and ibuprofen around the clock, and use opioids only as needed to
treat breakthrough pain. One important note: Avoid the use of NSAIDs
in patients with peptic ulcer disease and associated risk factors such
as smoking, drinking, bleeding disorders and renal disease.
• Discuss appropriate use. Remind patients that they should use
the pills they'll receive to treat only their surgical pain. Inform them
that opioids are known to be addictive and can even cause overdose
when used incorrectly. Also review how to properly dispose of
unused pills — the vast majority of prescription opioids in the com-
munity are stolen out of homes — including drop boxes at healthcare
facilities and police stations or mixing the pills with kitty litter or
charcoal before tossing them in the trash.
Safety
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