07 Feb Beating The Opioid Epidemic With Multimodal Pain Control
As most patient and physicians have heard by now, we are in the midst of an opioid epidemic. Providers and pharmacies are doing their best to limit opioid prescriptions, due to dangers of addiction as well as the side effects. In many ways, opioids can hinder the post-operative rehabilitation effort. Opioids cause sedation as well as other side effects, which limit participation in physical therapy as well as deep breathing. This can lead to a multitude of issues during the post-operative course, including muscular atrophy/deconditioning, as well as pneumonia.
To find the optimal way to achieve post-operative pain control, many of us have recently started championing a multi-modal approach. This includes using multiple non-narcotic pain medications, each with a different mechanism of action. Each utilized medication targets different pain receptors. Studies have shown that this approach actually has a synergistic effect on pain control, in which the total pain relief is superior to the sum of the parts.
A combination that has gained recent traction is celecoxib and a gabapentinoid (either pregabalin or gabapentin). Celecoxib is a powerful anti-inflammatory; however, it is a selective anti-inflammatory and thus does not have deleterious effects on wound and bone healing after fusions. Gabapentin and pregabalin are powerful nerve pain medications. Studies have shown significant decrease in opioid requirements post-operatively when a multimodal pain regimen is utilized.
I am an advocate for using both celecoxib and gabapentin post-operatively. This has allowed us to decrease the amount of narcotic medications that our patients require. The end result is a quicker and safer post-operative experience that gets the patient functional and back to doing the things they love!
Here is a list of relevant literature if you would like to read more about this topic:
Peng C, Li C, Qu J, Wu D. Gabapentin can decrease acute pain and morphine consumption in spinal surgery patients: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017;96(15):e6463. doi:10.1097/MD.0000000000006463
Liu B, Liu R, Wang L. A meta-analysis of the preoperative use of gabapentinoids for the treatment of acute postoperative pain following spinal surgery. Medicine (Baltimore). 2017;96(37):e8031. doi:10.1097/MD.0000000000008031