This post is sponsored by Pacira and SheKnows Media.
A few weeks ago, I attended a panel discussion of physicians hosted by Pacira Pharmaceuticals while at the BlogHer Health conference in NYC. They were there to discuss Pacira’s drug EXPAREL and other non-opioid postsurgical pain management options. Over the past year, I have spoken about the opioid epidemic and the importance of non-opioid pain intervention at physical therapy conferences in Illinois, Missouri, Florida, and New York, so I was encouraged by the physicians’ sensitivity to the complexities surrounding the opioid epidemic and their understanding of the importance of pain management.
The panelists included an oral surgeon, a plastic surgeon, and an orthopedic surgeon – each of whom serves a unique patient population. Though enthusiastic proponents of the drug, they recognized that EXPAREL isn’t a cure for the opioid epidemic, nor is it a perfect solution for addressing all postsurgical pain. Instead, it’s a long-acting non-opioid medication that a surgeon injects during a procedure, and which can help control the early days of postsurgical pain to limit the need for opioids. Because surgery can often become an accidental gateway to opioid use or abuse, circumventing the postsurgical pain experience can help to reduce that risk.
The opioid epidemic is changing postsurgical pain management.
One of the panelists, Dr. Gregory Greco, is a plastic surgeon in New Jersey and NYC who called EXPAREL a “game changer.” Another panelist, Dr. Paul Sethi, is an orthopedic surgeon in Connecticut who believes that a provider is the “caretaker” of his patients’ pain. They all agreed that the patients’ expectations going into surgery play an important role in post-op recovery – which I think applies to nonsurgical medical interventions too.
The physicians discussed how the opioid epidemic has changed their conversations with their patients, who often now request opioid alternatives. They also recognized that their patients’ goals – which should ultimately drive all treatment decisions – are the reasons that opioid therapy is often contraindicated. Patients want to resume their active lifestyles, return to work, and minimize the risk of addiction to their pain medications. The providers stressed that the opioid epidemic has shone a light into an area of surgical care that was previously an afterthought; where conversations once focused most heavily on what would happen in the operating room, the discussion now veers quickly to postsurgical pain management. Patients want non-opioid options, and providers are working to accommodate this request in ways that will still provide adequate pain relief.
“But what about women’s undertreated pain?”
I’d been furiously jotting down notes and felt that one stone had been left unturned. I often read (and write!) about how women’s pain is often undertreated, misunderstood, or disbelieved. I experienced this first-hand when I suffered from chronic pelvic pain, but also when I struggled to cope with acute postsurgical pain on several occasions. It’s a helpless feeling when you’re both unable to control your pain and unable to convince those who control access to pain medications that you’re truly suffering.
I posed my question to the panelists: Are they concerned that the emphasis on non-opioid medications and the effort to reduce opioid prescriptions will hurt women whose pain is already undertreated? How do they ensure that women aren’t denied access to necessary medications, even if those drugs happen to be opioids?
Dr. Greco offered an interesting response: Most of his patients are women, so he must be responsive and attentive to women’s complaints of pain. The elective nature of most of his procedures also means that his patients are typically better prepared for the postsurgical healing process, and that he trains his staff to hear patients’ concerns.
The panel offered some thought-provoking insight, and I’ll be following up on these topics in subsequent blogs.