Eugene Viscusi, MD, director of acute pain management at Thomas
Jefferson University Hospital in Philadelphia, Pa.
Here we are 13 years later, in the throes of a worldwide narcotic
abuse epidemic, and we address the issue once more, this time with an
opioid-sparing cover. The patient's still hurting, but she's not getting
any Vicodin, Percocet or Oxycontin, not when writing a prescription
for pain pills is like lighting up a cigarette in a crowded restaurant. Not
when, as you'll see in "Battle Post-op Pain Without Opioids" on page
26, a multimodal approach will do the job: regional anesthesia, single-
shot nerve blocks, pain pumps and non-opioid analgesics.
"We are now battling the overuse of opioids for most types of pain
treatment while introducing multimodal analgesia techniques with
more rational use of opioids," says Dr. Viscusi.
But has the post-op pain pendulum swung too far the other way?
Have we gone from overtreating pain to once again undertreating it?
Consider:
• ER doctors at St. Joseph's Regional Medical Center in Paterson,
N.J., no longer dispense opioids, instead treating broken bones and
kidney stones with nerve blocks, anti-inflammatories and other non-
narcotics.
• New CDC guidelines on prescribing opioids suggest you limit the
drug's duration for patients in acute pain to 3 days or less in most situ-
ations.
Maybe the answer lies in outsmarting the problem. A new opioid,
Xartemis XR, is an oxycodone and acetaminophen extended-release
formula that's been formulated to reduce abuse. You can't snort it or
inject it. In the war on drugs, it's a start.
OSM
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