The U.S. makes up just four percent of the world’s population, yet Americans consume up to 95 percent of the world’s narcotic pain killers. In the middle of an opioid epidemic, how do we cut back? One plastic surgeon shares his strategy – significantly slashing the number of narcotics he prescribes.
“With all surgery there is going to be some level of discomfort," Dr. Lawrence Iteld, a plastic surgeon, said.
From tummy tucks to breast implants to liposuction, the procedures range – and so does the degree of pain and discomfort.
“That’s what we were trained to do. And whether it was in medical school or residency -- patients have pain, give them narcotics. Patients have more pain, give them more narcotics. And we relied on it," he said.
And so many patients expect the pills.
“They remember when they had other surgeries done and their doctors gave them 30, 60, 90 tablets. Grandma had her knee replaced and she was on narcotics for six months. They are used to that, and that is the accepted norm," Dr. Iteld said.
But it's not the norm for plastic surgeon Dr, Lawrence Iteld. His practice of prescribing little to no opioid pain killers stems from personal experience.
“It was when I had my wisdom teeth taken out during medical school. I took a Vicodin, and I got really sick from it. Then I took Advil and felt better than I had on the narcotics. So, the question is, ‘Can I extrapolate that to patients?’ Opioids work at different parts of the body. We know they work in the brain, at the spinal level and further out at the tissue level. But they are sloppy drugs, and they have a lot of side effects and they don’t treat some of these symptoms really well," Dr. Iteld said.
Symptoms like tightness, throbbing and burning – common discomfort following many of the procedures Dr. Iteld routinely performs.
“I kind of figured it would be painful," Amanda Pezzullo, breast augmentation patient, said.
Six weeks ago, Pezzullo underwent breast augmentation, something she had thought about having done for years.
“I felt a little groggy because of the anesthesia, but it just really felt like I had done 100 pushups and that was really it. And just a little achy," Pezzullo said.
No narcotic pain pills needed. Instead, Amanda took a combination of anti-inflammatories, muscle relaxant and a medication to decrease nerve sensitivity. And during surgery, Dr Iteld injected a numbing agent to keep her more comfortable during the first 48 to 72 hours post-surgery.
“So really, other than plain Tylenol, patients are rarely requiring any as-needed pain medicine," Dr. Iteld said.
“Because I was so pain free, I felt like I was perfectly fine to lift up these weights, and I had to remind myself I actually can’t lift up a 45-pound plate because I need to pay attention to my recovery," Pezzullo said.
“Even if you can’t eliminate narcotics, if you can prescribe less it will really start to cut down on some of the major societal issues we’re having with opioids," Dr. Iteld said.
There has been some progress – the Centers for Disease Control has made a push to limit opioid exposure in chronic pain sufferers, particularly addressing prescriptions written by primary care physicians. But experts say a deeper cultural shift is needed.
“We have a low threshold or low tolerance for any discomfort or any feelings of ill-being, and that’s unusual in a developed world," Dr. Kenneth Candido,pain medicine physician at Advocate Illinois Medical Center, said.
Dr. Candido he treats patients suffering with back, neck and headache pain among many other chronic and degenerative conditions and is constantly trying to reduce opioids for his patients. Instead, he attempts to find the source of the pain rather than throwing drugs at the symptoms.
“I think that the expectations need to be commensurate with reality. We’re not going to eliminate most peoples’ pain. We can certainly change the way the body responds to that insult or injury, but we’re not going to be able to totally eradicate what caused them to come to our attention in the first place," Dr. Candido said.
Chronic use of opioids and addiction often begin with a legal prescription. That’s why alternatives to pain control are so important. That doesn’t hold true for patients suffering with cancer pain or those in end-of-life care, where narcotics may be necessary.
For more information about Dr Iteld, check out driteld.com.