American Society of Anesthesiologists Announces Tips for Pain Management with Opioids

American Society of Anesthesiologists Announces Tips for Pain Management with Opioids

The American Society of Anesthesiologists (ASA) cited the potential dangers of opioids in a press release this week, noting that “each day 44 people die from opioid overdoses and 80 percent of those deaths are unintentional.” The society also noted that opioids play an important part of managing moderate to severe pain.

“About 100 million people suffer with chronic pain and many of them rely on opioids,” said Daniel J. Cole, M.D. president of the American Society of Anesthesiologists (ASA). “When managed safely and carefully, opioids can be effective, but patients need to be careful with these medications. It’s vital that they talk to their pain medicine specialists about using them safely and also exploring alternative options.”

The society issued the following five tips on managing pain with opioids.

  1. Talk with your physician: If your physician prescribes an opioid (common ones include fentanyl, oxycodone and hydrocodone), be sure to have a detailed conversation about how to minimize the risks. Your doctor will ask if you have taken opioids before (and if so, how they affected you) or have a history of addiction as well as assess whether any conditions you have could increase the risk of side effects. Possible side effects range from mild (such as sleepiness or constipation) to more serious and life-threatening effects, such as shallow breathing, slowed heart rate and loss of consciousness, which can be signs of overdose. Ask your physician what signs to look for and how to minimize potential problems. The ASA has information about the signs of opioid overdose and what to do about it – learn more at asahq.org/OpioidODFacts.
  2. Take as directed: Because opioids are easy to misuse, be sure to carefully follow directions for taking them. Ask your physician about interactions with other medications you are taking or with alcohol.
  3. Plan ahead for surgery:
    1. Before surgery – If you are already taking opioids for chronic pain and are having surgery, be sure to talk to your surgeon, physician anesthesiologist and other physicians to determine how to manage pain before, during and after surgery. It’s important to understand that chronic opioid use increases the risk of complications from surgery and may add to the length of your hospital stay.
    2. After surgery – Even if you do not usually take opioids, you may be prescribed an opioid to cope with pain after surgery. If so, take the medication only as long as necessary for pain control – two weeks at most. If you find you are still in pain a few weeks after surgery, tell your pain medicine specialist so you can explore other options for pain control.
  4. Ask about combination therapy: Only about half the people taking opioids say they feel they have control of their pain. A newer method of pain control, multi-modal therapy, uses a combination of medications or other methods. This may not only help improve your pain management, but decrease the opioid dose you need to control your pain.
  5. Consider non-drug therapies: Biofeedback (in which patients learn to control involuntary functions, such as heart rate), meditation, massage, acupuncture, surgical procedures and interventional therapies (such as nerve blocks) can help with chronic pain. Talk to a pain medicine specialist to learn what options might work best for you.

The society noted that before taking opioids, patients should have a conversation with his or her physicians to understand how the medication will affect your body and how to use them safely.

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Authored by: Staff

There are 13 comments for this article
  1. Cathy at 9:06 am

    I have been a chronic pain patient for over 10 years now. I am disabled and my only income is disability income. I have to live with my ex-husband because I lost my home due to medical bills and losing my job, and I now have so much medical debt my credit has been destroyed.
    I went through 3-4 surgeries on my spine. I did the psychologist pain program where you learn to think positive about your pain; you learn coping mechanisms and things to do to manage your pain. I did the biofeedback thing, and Medicare didn’t pay for that, I had to pay for it out of my pocket years ago. I have physical therapy at least once a year when my pain gets really bad. I went through a number of medications, two of which I had to be pulled off of because they did damage to my heart.
    I was bounced back and forth between my orthopedic surgeon who wanted to do more surgical procedures that I just could no longer afford, and a pain doctor who only wanted to do intervertebral injections and steroid blocks (none of these methods lasted very long). Finally they sent me to a pain management doctor at UT Physicians in Houston. She had me sign a pain contract and do blood tests and urine tests and even some DNA cheek swab thing. She finally put me on a low dose of MS Contin ER taken every 12 hours and Vicodin for break through pain taken once every 8 hours. I used Lidoderm pain patches for the nerve pain in my lower back, and she helped me control my severe migraine headaches that even pain medication couldn’t stop with a drug called Naratriptan. I take a huge dose of Gabapentin daily (took me months to get used to it), and I take Trazadone at night to help with sleeping.
    This seemed to get things under control for me and for the past 5 years I have done relatively well. I started doing my crafting again, and being more active around the house. I walk with a cane, but I did use a walker, but after getting onto her management therapy the walker stays in my closet.
    Two years ago I started having trouble with my local CVS pharmacy that refused to fill my pain medicine. They would tell me they were out of stock and it got to be where my family had to drive me all over town trying to find a pharmacy to fill my medication. We finally found a mom and pop pharmacy located upstairs from my doctor’s office. So I had all my medications transferred to them and would coordinate getting my prescriptions filled with my doctor appointments. Last year I went to see an Internist and she did in-depth blood work and found high markers for Rheumatoid Arthritis. So now I have to take Humira or an equivalent.
    After 5 years of finally getting relief and becoming active again, I found out last week my pain doctor is getting out of the pain management business altogether. She is getting into a completely different field of medicine and it’s because of the liability and risk to her medical license for prescribing pain medications. She just doesn’t want to risk it anymore. I have two months till my last appointment with her. I have two months to try and find a pain management doctor. I have called about 6 different “pain management” clinics and several doctors of osteopath and all of them won’t even schedule an appointment with me. They are not taking any more pain patients. Only two offices have told me that I have to have my current pain doctor fax them the past 6 months medical records with her office and a list of ALL the medications I have been on or are currently on before even considering making an appointment with me. I even asked my current pain doctor if she could start working on weaning off all these pain medications so I am not going into abrupt withdrawal and she said she cannot because that means putting me on other new medications and monitoring me and she is just giving me the courtesy of giving these two months to find someone. This is where I am left folks.
    I can’t get seen by a Pain Management Doctor and I can’t even get my current one to try to help me safely get off these medications.
    So this has brought up so much anxiety in me at the moment. I fear I am going to end up without getting a doctor in time and go through severe withdrawal. The chances are good this will put me in the ER.
    I understand that there is a great deal of pressure from the CDC and the DEA but Jesus Christ folks this is not the way to handle things for chronic pain patients. Let me say one other thing to you people who treat people like me like some druggie and flippantly say “why don’t you try other methods and use alternative treatments?” I have! All those wonderful alternative treatments have bankrupted me, and they have put collection agencies after me and killed my credit. I couldn’t rent an apartment if I wanted to because of what all this medical debt has cost me.
    The pain medications that so many people are saying are so evil and that the risk of abuse is greater than the alternative treatments, you need to think about the enormous costs to these alternative treatments. I have had my orthopedic doctor drop me as a patient because I was unable to pay off the 6 thousand dollar bill that was left over from all the “alternative treatments” and surgeries that Medicare didn’t pay. I had a pain doctor drop me years ago because I couldn’t pay off the 4 thousand dollar bill left over that Medicare didn’t pay for all those monthly spinal injections.
    People like me have tried everything under the sun to cope and manage our pain, and end the end the pain medications were by far the least costly and most effective. I know because I was on the long term. This has gotten out of hand and the CDC should be ashamed of themselves and so should our Government for doing this to people like us.

  2. Carol at 4:29 pm

    I am a 71 yr. old woman with many pain problems. First I want you to know that I am not lazy and wish I could be like so many of my friends; healthy and active. I use to own the largest yacht detailing company in Washington State. I then developed with the help of a chemist a line cleaning products; I have distributors all over the US. I am unable to travel and do shows or see my distributors because of my pain condition.

    In the 1981 I was in a camper explosion I had 3 degree burns. Two years later I had the first of 3 neck surgeries related to that accident leaving me in constant pain (I’m a pain in the neck)/ There are many stressors that happened to me that were very hard including my wonderful husband who died at age 39. My body went into warp speed, I could actually feel this and for a few years I was unable to stay still literally. I then got hepatitis and Mononucleosis at the same time; still I was unable to stand still even with these illnesses. I am fortunate in that I am not depressed and have a positive attitude.

    I fell and tore ligaments in my foot, I had a few surgeries (I’m older and wiser now and would not have had the surgeries; I trusted Drs.) my left foot is now in pain and is contorted.

    In the early 90’s I saw a very qualified Dr at Minor & James Clinic in Seattle, he was a rheumatologist. After several visits he told me I had Fibromyalgia, my grandmother and aunts had this too. My FM is very bad and in my opinion all the surgeries (some I won’t list now) I had and the burns probably made the FM worse.

    I continued to work hard through the pain in both my detailing business and now my product line. Finally I had to stop detailing. My Rheumatologist tried several medicines on me that I could not take. I went to the Univ. of Washington Fibromyalgia Study for months and tried many other things to help the pain. Finally in the 90’s oxycontin became available and my Dr. started me on this. I have been on 20 mil 3x day for all these years; I never took extra pills in all that time. When oxycontin isn’t working as well I decided to take less for a week or two. When I went back on my regular dose I could tell that oxycontin worked as before. My Dr thought that was a good idea; I repeat this program when I need to.

    We moved from Seattle to Northern Idaho in 2011, no Dr would take me because I was a pain patient and on oxycontin, not even a GP. I picked a GP and wrote her a resume as if I was trying to find a job. I wanted her to know me and hopefully accept me as a patient; she did but she would not prescribe my oxycontin. I had to travel to Minor & James Clinic which was 800 miles round trip every quarter where my Dr saw me and kept me on the same program.

    My Dr in Seattle retired and then real h*ll began. The Dr that took over for him did not want to prescribe oxycontin but since he took over for my retired Dr he kept me on his program. This new Dr. then changed Clinics (so he could get rid of all my retired Dr’s patients), another Dr took his place and she did NOT intend to keep me on oxycontin. I saw her once and then got a letter from Minor & James Clinic (they are part of the U of W hospital), it said that they were not going to keep me as a patient, they actually threw ALL PAIN Patient out of their clinic! Other Dr’s did the same thing in Seattle. I find that experience to be unbelievable and not fare to pain patients. I often wonder if a good lawyer would have been useful, maybe as a class action suit where many pain patients could make a difference. I couldn’t afford it, I am in too much pain to put the effort it would take to get our story out.

    I am 71 and the only help for all the pain I have 24/7 is being classified by CDC as dangerous; now my life is upside down. I am scared because I know the real pain once I stopped taking my medication and I have a heart problem and going through a withdrawal could kill me.

    Thank heaven I found a pain clinic in the little town we moved to. They kept me on my program but the CDC has plans to make getting meds hard for everyone, the Dr’s to. I am very scared of the future and what the government is trying to do to people who take oxycontin and other pain pills. On March 17 Fox News had a section on getting all pain patients off of pain killers. All news or stories on opioid never points out that pain patients are helped by pain medicine; according to the CDC we are part of the addiction problems. They are lumping us in with those addicts; it just doesn’t make sense. I have been a perfect patient and I am sure most of us are. What happen to common sense?

    The pain clinic had a representative from Proove Inc. a DNA company. She asked me if I would give them a sample of my DNA and I did. I was very happy when I got my results. My test showed I don’t have an addictive personality and when I say I am in pain I am in a lot of pain.

    I don’t know if you have had experience with DNA for pain patients, I think it would be a good tool for Drs. I do know that Drs. are under a lot of stress and lots more work has been heaped on them by the government.

    The funny thing about oxycontin is it doesn’t do damage to your organs like all the other medications they are putting out IE: ibprophen which is very bad for people. No one ever talks about this. Yes, oxycontin and other meds are dangerous if you don’t follow directions, I think most of us don’t abuse our medication. You can get in trouble with any medication. Addicts are using many concoctions to get high, here is a good example of this. Why aren’t they removing all bath salts! http://johnsaddiction.com/6698-meow-meow-ephedrone-bath-salts/

    The CDC and others are telling us that they want all people off pain meds and they want Dr’s to give only a week at the most. This would be a terrible thing to do to us and Dr’s and pharmacies. It is not the government’s job to get involved with our Dr’s and Patients. I’ve included a link that goes over the cons of what the CDC wants to do. Please help make pain patients lives better; we are not being treated fairly.

    Bath salts http://johnsaddiction.com/6698-meow-meow-ephedrone-bath-salts

    http://www.painnewsnetwork.org/stories/2015/9/22/chronic-pain-groups-blast-cdc-for-opioid-guidelines

    From the paindr http://paindr.com/morphine-equivalence-med-medd-%E2%89%A0-cred/

    New research on Fibromyalgia, this is very good and from credited dedicated doctors and research hospitals.

    http://www.usatoday.com/story/news/nation/2013/12/15/fibromyalgia-research-breakthrough/3991063/

  3. Kell at 3:24 pm

    I have been taking legally prescribed opioid pain meds for 7yrs.I’m under the care of numerous doctors.I always keep them updated on all my meds&supplements I take.My Neurologist/Pain Specialist is the only Dr.who prescribes my pain meds.I have a drug contract with her&have always followed all prescribing instructions.She has told me she trusts me&knows I do not abuse my meds.I have never attempted to refill early&I listen to her.I have been through numerous alternative treatments.I have learned some coping techniques&do use them.Some things help, but by no means do they keep me@a tolerable pain level.My quality of life is no where close to what it was before a major back injury&surgery.My surgeon informed me before surgery that I would always have some level of pain.With the meds I am prescribed most of the time I have learned to live with a certain amount of pain.Have to watch every thing I do very carefully. If I overdue something a little, the price I pay after is overwhelming!Not easy to always know what is too much.Since surgery I’ve been diagnosed with some serious diseases’.Adds to my pain tremendously!Bedridden&sick alot of the time.Try to stay as positive as possible.(Not always easy.)Meds are always hidden,only my husband& myself know where the place is.We change it frequently. Only the 2 of us@home.I had 2,”so called very close friends,” who had out of the blue, suddenly showed up to help care for me to an extreme. Well,surprise!!They would somehow find my meds&were stealing them!Talk about the hurt&betrayal I felt.We realized pretty quickly&banished them from our home&life!Don’t feel like you can trust others to not do the same.Addicts will do anything to get their hands on your meds!!These are the “people?”who make it hard on those of us who actually live 24/7 in pain.So,on those occasions I went w/out MY prescribed meds.I didn’t want my Dr.thinking I was not following my drug plan.Makes me extremely hurt&angry!We, the honest people in pain,pay the price for those who abuse! Yes, I should have reported this.At the time I was very ill& not up to dealing w/it.Yes,an excuse.WE DESERVE TO HAVE A SOMEWHAT PAIN FREE QUALITY OF LIFE!

  4. HAZZY at 1:47 pm

    A MASSAGE, BIOFEED BACK AND A POOL DOSENT DO ANYTHING !!!!

  5. Debra at 1:33 pm

    I hate being on all this pain medicine but with all I take I am still in pain and some days I cannot stand it. I have multi level bulging discs up and down my back, spinal stenosis, now diagnosed with degenerative disc disease in my neck giving me huge knots in my back. I need som help. I take 30 mg morphine 3x a day and 10/325 percocet for break through pain which never really seems to help. heated bags of corn seem to help but have to be reheated every 30 minutes or so. I also have neuropathy in feet, legs and hands and osteoporosis arthritis in all my joints.

  6. Brenda at 6:33 am

    I would love to have the option of other ways to control pain. Unfortunately most of us can’t afford to. Insurance will not cover it. Massage, biofeedback, access to a pool. How are you going to get insurance to cover that?

  7. HAZZY at 1:13 pm

    Ive been on Opioids for over Ten years, they are given to me by my wife because i had a theif
    take my meds, they are locked in a lock box and then in a safe!!! I take my MEDS as Prescribed, these people taking MEDS without a script, are making it bad for us that take there MEDS as Prescribed………IM, MADDER THEN H*LL WITH PEOPLE GETTING DRUGS AND DONT NEED THEM, MAKES IT BAD FOR PEOPLE THAT TAKE THERE MEDS AS PRESCRIBED…………………..THANKS

  8. Jean Price at 10:20 am

    Well, they are supportive in a way…yet why did they use the same bogus figures about overdoses of opioids instead of citing only two to three percent of patients taking opioids legally prescribed for pain EVER become addicted?? Guess that would be asking too much. I suppose they have a vested interest in continuing to prescribe, and to show they’re the specialists…since patients will eventually stop seeking medical help and just take to their beds versus being abused, under dosed, and classified as addicts! This way they keep us coming back for a thin life line. I sound pretty critical don’t I? Well, watching all these clowns denying treatment for pain and having twenty five years plus of chronic pain maybe gives me the right! And the biggest issue is the needless suffering people are going through!

  9. B WAITT at 9:19 am

    non-drug therapies: Biofeedback, massage, acupuncture, chiro. etc etc. on $1178.00 a month SSD. who will pay for these therapies ? I can live in the dark, NOT shower, live in a room in a strangers home. eat rice/noodles perhaps then I can pay for some alternative therapies………..oh and surgical procedures and interventional therapies (such as nerve blocks) NO WAY ! I have sold all my belonging for the monthly pee tests, doctor appts & drugs as it is.

  10. HAZZY at 9:19 am

    IF PEOPLE WOULD TRY AND STOP TAKING MORE AND MORE PAIN-KILLERS!!! WE WOULDN’T HAVE THIS PROBLEM. I’VE BEEN ON OPIOIDS FOR TEN YEARS, THEY ARE TAKEN AS PRESCRIBE, IF I CAN DO IT !!!! I DONT KNOW WHY EVERYONE ELSE CAN’T, SO IF THIS LAW IS PASSED WHO IS GOING TO PAY FOR ME TO GO THROUGH WITHDRAWAL ???

  11. TIm Mason at 7:11 am

    So it looks like those of us that are under the care of a Pain Specialist that is also a trained Anesthesiology thaw we are in “good hands”. My physician is and my neurosurgeon recommend physical therapy of which I just completed 33 visits. These visits also included a massage for my piriformis area problem which was fantastic. I will continue with the clinical massage as needed.
    Of course the goal of PT is to reduce your breakthrough medication. Know your limitations when working with these therapists. My first two sessions almost sent me to an emergency room. (I could not lay on a half roll down the length of my back and stretch my arms).
    Here is what I gained from PT: 1.The ability to squat. 2. Improved body mechanics and posture to limit further damage to lower back. 3. Learned the correct way to get in and out of bed.
    I always told them that I was taking my morphine prior to the visits. I attempted to cut a dose out of my daily schedule with negative results. I made sure this went into their notes.
    On our initial visit your will complete and Owensby Disability questionnaire. Keep a copy of your evaluated report for your records.
    If you complete the required PT you will have done your part of the new guidelines.
    Documentation is your friend.
    I also discovered that there is a way to communicate with pain specialists. They are busy people and under a great deal of stress and so is the office staff.
    Be nice as you can but speak up for yourself. Physicians need to be allowed to diagnose your problem. They have big egos and that ego needs to be feed. I searched something like “How to deal with angry doctors” “Why is my doctor so angry”. Interestingly enough, the best advice came from doctors themselves.
    ——
    I would like information about David’s books. ISBN number will be fine.

  12. Doug at 5:59 am

    If patients follow the doctors instructions when taking opiates they will manage their pain to a tolerable level and be safe. The problem is that so people are under medicated because of all this rhetoric coming from the government’s alphabet squadrons, (DEA, FDA and CDC). Physicians are afraid to prescribed and pharmacists are afraid to fill for the fear of loosing their licenses due to over prescribing. The fact is that as long as patients follow their doctors instructions and don’t self medicate by not follow the instructions, opiate overdose deaths will be minimal.
    Also the actual overdose deaths due to suicide needs to be looked at again and studied in a lot more detail. I can guarantee that 20% is a very low estimate and it has a lot to due with life insurance benefits. Suicide should not disqualify life insurance payouts because in all cases death is due to a disease, clinical depression is a disease. If insurance companies had to pay out for deaths due to suicide, that 20% would grow to 75% or possibly even higher but families are scared to admit a loved ones death a suicide for fear of loosing benefits.
    Then the facts about legally compared to illegally obtained prescription medication overdoses haven’t been pointed out.
    So my point is that, how could there have been a trial based totally on circumstantial evidence?

  13. Bob Schubring at 5:31 am

    It’s probably a mistake for the anesthesiologists to rely on the CDC’s body count, because the raw data from which the count was compiled, does not distinguish deaths of patients from deaths of people using illegal drugs. The actual danger to patients, thus, is much less. Doctors and pharmacists warn patients not to drink alcohol while using opioids. Black-market marijuana and crack dealers who also re-sell stolen opioids, don’t do this kind of patient education, and it’s leading to overdose deaths. The best way to reach these potential victims is by advertising on TV, about why it’s smart not to drink while taking opioids, Not every drug abuser is suicidal, and trying to reason with people to get them to take fewer risks, actually does save lives.