I made a comment on Twitter about my own experience with post-surgical pain last week that had people encouraging me to write a first-person account.
First of all, I am not a chronic pain patient. I have endured back pain for four decades, but it’s sporadic and not chronic.
So, for many who read this, this will seem quaint but not necessarily relevant.
That said, here’s my surgery story—which was actually a second surgery for me.
Last December 1st, while on business in Miami, I was struck rather suddenly with abdominal distress that resulted in an emergency surgery for a bowel resection. The surgery was straightforward, but the recovery wasn’t. I was in ICU for a week (which I barely remember), contracted sepsis, was in the hospital for nearly three weeks total, lost 30 pounds and started the long road back to full strength.
I finally returned home to Los Angeles the day after Christmas—and was pretty feeble.
I was determined to get going again—and had my physical trainer come to the house three times a week and we started to build back my fitness.
I do exercise vigorously and may have come back too fast too soon—because in March I noted a bulge in my upper abdomen. I went to my primary care physician who recommended a surgeon and found that the bulge was what they call a ventral incisional hernia.
While waiting for the surgery—I continued to exercise which made the hernia bigger—but I like to exercise and was told I couldn’t do any more damage.
The surgeon—who I really like and would go back to as a patient again if the need arises—performed the two-hour surgery on April 16 and sent me home the same day, prescribing Tramadol for post-surgical pain.
I was hurting the next day—and called the surgeon—and said, “Doctor, what you prescribed isn’t touching my pain.”
He apologized—and said that the scrutiny of the federal government has impacted prescribing behavior—and suggested I double the dose.
I did—it didn’t help much at all.
On the second day, the pain was still pretty intense and my wife reminded me that she had some unused Oxycontin from a hand ligament surgery a year ago. I took that for the rest of the day. By the third full day of recovery, the pain really subsided and I didn’t need anything stronger than anti-inflammatory over the counter medication and a Xanax at night because I was pretty stressed about my experiences from the previous six months.
Happily (and gratefully) my recovery from the second surgery has gone well. I followed the doctor’s instruction not to exercise much for six weeks and have just begun to pick up the pace.
I hadn’t reflected on the post-surgical pain issue much until I saw some Twitter posts and when I joined the conversation it seemed to ignite some additional dialogue.
Look, I understand and sympathized that the “crackdown on opioids” is causing self-protective behavior from doctors who are fearful of the government and its unwelcome scrutiny.
And all of us know that the government getting between the doctor and his/her patient has caused damage that is hurting people who have used opioids responsibly to treat their chronic pain.
As Stanford’s pain psychologist Beth Darnall said to me via Twitter last week, health care professionals “must assess each patient’s response and address their individual needs after surgery,” she wrote. “Problems arise when research results are interpreted rigidly as rules.”
She’s right—absolutely right from my point of view.
And, without a doubt, the conversation about opioid therapy has become more moderate—the recently approved HHS Pain Management report and utterances from both the FDA and CDC all have shown that the opioid pendulum swung too far and too fast away from patient care.
But the hard truth is that the overreaction from the DEA and the CDC Guideline on Opioid Prescribing continues, and the medical practitioners and the people they treat need to speak up.