A holistic approach to surgical pain: Moving toward opioid-free recovery

Amid the growing opioid crisis and a rising interest in alternative therapies, UPMC Shadyside has introduced a transformative approach to surgical pain management. This program enables patients to opt for surgeries without relying on opioids, paving the way for a new standard in healthcare. By focusing on reducing addiction risks and empowering patients to take charge of their pain management, the opioid-free pathway marks a significant shift in medical care practices.

Addressing the opioid crisis

The opioid epidemic has devastated countless lives, with opioid use disorder affecting millions. Once common for surgical pain, opioids are now linked to addiction and long-term health issues. Studies reveal 80% of new users get their first prescription from a healthcare provider. Recognizing the risks, hospitals like UPMC Shadyside are finding safer pain management alternatives.

Dr. Shiv Goel, chief of anesthesiology at UPMC Shadyside, launched the opioid-free pathway after numerous patients requested alternatives. “We saw patients asking not to use opioids for pain, but no clear option existed to honor their choice,” he said.

Patient concerns and awareness

Increasingly, patients are expressing concerns about opioid use, particularly regarding the risks of addiction and dependency. This growing awareness has put pressure on healthcare providers to explore safer alternatives. Patients now seek assurance that their pain can be effectively managed without exposing them to the risks associated with opioids. This shift in patient expectations has driven the development and adoption of opioid-free anesthesia and multimodal pain management approaches.

Exploring opioid-free anesthesia

At the heart of opioid-free anesthesia lies a multimodal strategy that targets multiple pain pathways simultaneously. This approach combines various medications and techniques, each working through distinct mechanisms to reduce pain perception and enhance overall relief.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These medications, including ibuprofen and acetaminophen, work by inhibiting COX enzymes that promote inflammation, thereby providing effective pain relief at the surgical site and spinal level.

Gabapentinoids: Drugs such as gabapentin and pregabalin address neuropathic pain by reducing nerve inflammation and signal transmission, a key factor in postsurgical discomfort.

Ketamine: This anesthetic is particularly effective at disrupting pain pathways associated with central sensitization, a phenomenon where nerves amplify pain signals even after the injury has healed.

By combining these and other medications, healthcare providers create a synergistic effect that enhances pain relief while eliminating the need for opioids.

The opioid-free surgery model

This approach uses regional anesthesia, nerve blocks, local anesthetics, and non-opioid IV medications to manage surgical pain. These techniques target specific nerves to reduce pain, allowing patients to stay awake while avoiding opioids.

Post-operative care includes non-drug therapies like aromatherapy, acupuncture, hypnosis, and music therapy. These methods help reduce anxiety and pain perception, with studies showing benefits such as lower pain levels and improved emotional well-being.

Empowering patients with control over pain management

Pain perception is not solely a physical phenomenon; it is significantly influenced by psychological factors. Anxiety, depression, and sleep disturbances can heighten pain sensitivity by up to 50%. Research has revealed that patients with high preoperative anxiety levels often require more anesthesia and are more likely to experience severe postoperative pain.

Recognizing the psychological components of pain is essential for effective management. Addressing these factors can improve patient outcomes, reduce medication requirements, and enhance overall recovery experiences.

Complementary and alternative therapies

UPMC Shadyside uses alternative therapies alongside nerve blocks and local anesthesia to address both physical and emotional pain, focusing on chronic pain relief. Psychological factors like stress and anxiety can worsen chronic pain. UPMC Shadyside employs techniques like acupuncture, hypnosis, and music therapy to ease anxiety and reduce pain.

Acupuncture, for example, involves inserting fine needles into specific points on the body to stimulate the nervous system and release pain-relieving chemicals. Hypnosis, on the other hand, can help alter the brain’s response to pain by focusing on relaxation and reducing the psychological impact of discomfort.

Music therapy, another integral component of the opioid-free pathway, has been shown to reduce pain levels and anxiety in both acute and chronic pain patients. Listening to soothing music can help release endorphins, the body’s natural painkillers, while lowering stress hormones that contribute to pain.

Implementing opioid-free surgical programs

The University of Pittsburgh Medical Center (UPMC) launched the Opioid-Free Surgical Pain Management Program in May 2024 to reduce opioid use while ensuring effective pain relief. This multidisciplinary initiative involved surgeons, anesthesiologists, nurses, and administrators.

In its first six months, 109 patients enrolled, with 79 successfully undergoing surgery without opioids. The program was refined by adding muscle relaxants during recovery, enhancing patient experience. Notably, patients who needed limited opioids post-surgery didn’t require further prescriptions, showcasing the program’s success in managing pain without dependency.

Beyond surgical care, strategies to minimize pain in daily activities are gaining traction. Physical therapy, ergonomic adjustments, and regular exercise tailored to individual capabilities are proving effective in reducing chronic pain and enhancing mobility. Programs emphasizing lifestyle modifications also help patients manage conditions without resorting to long-term medication use, including opioids.

The future of opioid-free surgery

To ensure the continued growth of opioid-free surgical care, systemic changes are necessary across the healthcare industry. Key priorities include:

Training programs for providers: Healthcare professionals need thorough training in multimodal pain management and complementary therapies to confidently implement these methods.

Policy advocacy: Institutions and policymakers must promote guidelines that prioritize non-opioid approaches, fostering a culture of safer pain management.

Research investment: Ongoing research into new medications, techniques, and therapies will further refine opioid-free approaches, making them more effective and accessible.

As public awareness of the opioid crisis grows, patient demand for safer pain management options will continue to increase. Healthcare providers must tailor pain management plans to individual needs, ensuring effective relief while minimizing risks. This patient-centered approach is critical to the success of opioid-free surgical programs.

A holistic approach to pain management

The opioid-free pathway takes a holistic approach, considering emotional, psychological, and social factors, not just the physical sensation of pain.

Heather Margonari, lead coordinator of the pathway at UPMC Shadyside, noted that patients feel more alert and empowered. “Patients seem happier on the pathway, more alert, and empowered as their wishes are respected,” she said. Patients wear a special bracelet and have stickers on their charts to ensure consistent communication among the healthcare team for seamless pain management.

Healthcare professionals shaping the future

While the opioid-free pathway is a huge step forward, Dr. Goel emphasized that the initiative is part of a larger effort to shift the way healthcare professionals approach pain management. “There was a time when we started calling pain the fifth vital sign. We created unrealistic expectations for our patients,” he said. “I think we owe it to ourselves and our patients and to our country to try to right this wrong.”

By promoting alternative therapies and reducing the use of opioids, healthcare providers can minimize the risks of addiction and improve the overall quality of life for patients. The opioid-free pathway is a proactive solution to the opioid crisis, and it reflects a growing recognition that opioids should not be the default option for pain relief.

A model for nationwide change

The opioid-free pathway at UPMC Shadyside has the potential to become a model for hospitals nationwide, blending traditional and alternative pain management techniques to set new standards for surgical pain care. This holistic approach reduces opioid use while promoting evidence-based practices and alternative therapies for chronic pain. As more hospitals adopt similar models, opioid-free pathways could offer safer, more effective pain management solutions.

This model goes beyond eliminating opioids, focusing on a comprehensive care approach that prioritizes patient control, well-being, and long-term health. As the opioid crisis persists, UPMC Shadyside’s pathway offers a promising solution for managing chronic pain without the risk of dependency.