Mar 2, 2018Avoiding Opioids
As a sports medicine professional, helping athletes deal with injuries and the pain that comes with them is part of the job. For Bert R. Mandelbaum, MD, DHL (Hon), this involves an active approach to avoiding opioid addiction.
As written in an article for Medscape, Mandelbaum has seen firsthand how complicated the issue with opioids is for sports medicine practitioners. As a result, he has moved away from prescribing most opioids.
“Instead, I rely on preemptive blocks and long-acting liposomal local anesthetics. Typically, I inject ketorolac into the area around the joint before, during, and after the surgery. After surgery, I prescribe a variety of acetaminophen and nonsteroidal anti-inflammatories. I recommend ice, compression, and sometimes electrical stimulation. Only when these measures fail do I prescribe tramadol, a synthetic opioid. It does have some addiction potential, but much less than hydrocodone, codeine, or oxycodone,” Mandelbaum wrote.
In addition, he keeps the communication channels clear with patients and takes the time to monitor pain levels.
“Success in managing patients’ pain requires careful monitoring. I ask patients to score their pain on a 1-10 visual analogue scale. Not only does this help me analyze the situation of an individual patient, but it allows me to evaluate my success across my practice by averaging the scores of dozens of patients. And by participating in the Arthrex Surgical Outcomes System, I can compare my results with those of other physicians. I challenge all physicians to take on this level of pain management,” he wrote.
Mandelbaum feels it’s imperative for physicians to do all they can to help patients steer clear of addiction.
“As it stands, most people can’t get coverage for addiction treatment, and rehabilitation programs are relegated to the margins of medicine,” he wrote. “As physicians, we must attend to the psychological, emotional, and addictive aspects of our patients’ lives, even when the healthcare system does not.”
Within his practice, Mandelbaum has fostered relationships with rehabilitation programs so he has somewhere to turn when a patient needs referral. When working with an individual who is already enrolled in one of these programs, coordinating medical care with other physicians is important — particularly when it comes time to prescribe medication.
For those struggling with addiction, exercise may be helpful. Mandelbaum suggests this could be part of a treatment, but likely won’t facilitate a recovery on its own.
“I believe that exercise empowers people to discover that solutions are within them. It would be naïve to think that running is all that the average patient needs to recover from addiction. But in combination with behavioral modification and addiction medications such as methadone, it can provide powerful benefits,” Mandelbaum wrote.