Francisco Gonzalez | Unsplash
When I was 16 years old, I got my wisdom teeth out. The only thing I knew about the surgery was that it would be painful, and I would not be able to eat solid food for a few days afterward. I did not have a very high tolerance for discomfort, so when my doctor presented a pain relief option, I was more than happy to listen. He was planning to write a prescription for an opioid. However, my father was adamantly opposed to his teenage daughter taking a potentially addictive medication. I ended up taking ibuprofen and acetaminophen and I was fine.
A few years later, my friend, Alexandre, told me about when he was prescribed opioids. He was about 15 and needed knee surgery. His doctor warned him that he would be in significant post-operative pain, wrote a prescription for an opioid, and instructed him to fill it. In contrast to my doctor, Alexandre’s surgeon spoke at great length about how to manage his pain. If using over-the-counter medications kept the pain from interrupting his day-to-day activities, he explained, there was no need to take the opioids. Alexandre experienced discomfort, as his doctor predicted, but ibuprofen and acetaminophen were all he needed to cope with it.
When I hear about the opioid epidemic — and how millions of people in the US suffer from substance use disorders after being prescribed powerful pain medications — I find it alarming. It makes me think about what might have happened to Alexandre or me if we had taken prescription opioids. According to the Institute for Healthcare Improvement (IHI) report on Advancing the Safety of Acute Pain Management, research indicates that “adolescents who receive a legitimate prescription for an opioid during high school have a risk of opioid misuse as young adults that is 33 percent higher than in adolescents who do not receive prescription opioids.” I can’t help but wonder if Alexandre and I dodged a bullet.
As an intern at IHI, I believe several of the recommendations highlighted in the Acute Pain Management report may be of interest to young adults like me, including:
- Researchers and clinicians need to do more to support adolescents experiencing acute pain. According to research cited in the IHI report, a teenager’s social environment and stage of development puts them at risk for opioid misuse. While his doctor may have been acknowledging Alexandre’s relative maturity by setting clear expectations with him about pain, I wonder if he should have told him to fill the prescription before trying the over-the-counter pain relief. Given the risks, maybe he should have told him to fill it only if absolutely necessary.
- Help patients set realistic expectations about pain relief. I had the common misconception that I should be completely free of discomfort after I got my wisdom teeth out, so I was worried that ibuprofen and acetaminophen wouldn’t be strong enough. Maybe if my doctor and I had discussed my fears and a pain relief goal that focused on avoiding disruption of my daily life, I would have been less concerned.
- Non-opioid alternatives should be considered and offered more often. The US Department of Veterans Affairs published Acute Pain Management: Meeting the Challenges - A VA Clinician’s Guide in 2017. Noting the risks associated with prescribing opioids for acute pain, the guide offers a three-step approach to acute pain management. Step 1 includes non-opioid options that range from rest, ice, heat, and elevation to acupuncture, massage, physical therapy, yoga, and tai chi. Step 2 includes topical gels, solutions, or patches and options that include acetaminophen and NSAIDs. Opioids are only recommended for managing severe pain in Step 3 and only for short-term use of short acting opioids.
Doctors do their best to diagnose patients and give us the best course of treatment possible. As patients, we often listen to their recommendations without question. When treating acute pain, clinicians should offer non-opioid alternatives and we, as patients, should educate ourselves about these alternatives and learn how to ask for them.
Susannah Berlowe Binder is the IHI Multimedia Project Assistant.
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