It seems as if every day there is another media story like this one on NBC’s Today Show about the dangers of patients becoming addicted to pain medicines. This typically occurs after surgery when the patient is recovering from the procedure.
One Dallas joint replacement surgeon and participating physician member in the Texas Health Spine and Orthopedic Center referral program, Dr. Kwame Ennin, has developed a medication strategy which is designed to reduce the incidence of this addiction to prescription drugs. More on this later.
Originally from New York City, Dr. Ennin came to the Dallas-Fort Worth area to continue his medical training. “I came to the area to study, loved it and stayed,” he said in a recent interview.
He is an orthopedic surgeon focusing in total joint replacement surgery and sums up his approach to medicine by noting, “I help people get back to doing things they want to do by removing the pain – the barrier – that prevents them from having a good quality of life and I do this through surgery.”
Patients Addicted to Pain-Killers
As have many surgeons, Dr. Ennin has noticed an alarming increase in the number of patients who become addicted to pain medications.
“One of the issues endemic to medicine is having patients becoming addicted to these pain-killers,” he said. “Some of this has to do with the nature of these medications, where the medicine itself is addictive. In this case, the medicine affects the brain chemistry of the patient. In other situations, the patient might have a predisposition to becoming addicted. Those people are at greater risk.”
“We physicians are also somewhat culpable in this epidemic of medical addictions, because we have dealt with these people’s pain by passing out these medications.”
“One of the ways I have dealt with this problem is that I take pain very seriously,” he noted. “We have developed a very well-planned, multi-modal pain reduction plan that we use with our post-operative patients.”
Medications Which Can Lead to Addiction
There are two main types of medications which are used for alleviating pain that could trigger an addiction, Dr. Ennin explains.
“The main types of drug classification that can lead to addiction are the non-steroidal, anti-inflammatory drugs . Examples of this group are ibuprofen or Celebrex. These are used as pain medications, but they are in fact anti-inflammatories.”
“The other class of medications that are used to treat pain are the opiates. These are drugs such as oxycodone, hydrocodone and morphine. These medications have an addictive potential.”
A Unique Three-Pronged Approach to Pain Management
Dr. Ennin and his team have developed a specialized regimen for his surgical patients which helps reduce the number of medications needed after the surgery is completed. How does this work?
“This works because we have a much better understanding of what pain really is,” he said. “Although our brains subjectively experience pain in a particular, specific way, what we’re really doing is interpreting several different inputs in the same manner. The reason our multi-modal pain management system works is because we treat pain from the various perspectives.”
“We treat pain immediately before surgery – before any incisions are made. The patient is given a cocktail of medications to be taken by mouth that treat pain from several different perspectives. One is an opiate, which treats pain from the opiate perspective. Another is an anti-inflammatory medication which treats pain from this perspective and one is a nerve-type medication which treats the nerve component of pain. All of these medications work synergistically to reduce the amount of pain a patient might experience.”
“During the operation, we use an injection, which is a cocktail of medications which treat pain from a couple of different perspectives. A potent component of that injection is a numbing medication which is not too dissimilar from what dentists use to numb the gums during a dental procedure. This is formulated to last for about 72 hours. It doesn’t work for everybody, but it works for about 95 percent of our patients. This decreases the amount of pain the patient has during the post-operative period.”
“During the surgery, we also use something called IV-Tylenol, which is the same Tylenol that one can purchase over the counter, except this is formulated to allow us to deliver it via IV. This has the advantage of not having to go through the liver of the patient. When traditional Tylenol goes through the liver, it is metabolized in part and its potency is decreased. By giving it in the form of an IV, that potency is not affected in any way. That has the effect of decreasing post-operative pain.”
“In the post-operative phase, we give patients a cocktail of medications, where opiates are used as the last resort. Therefore, it’s not uncommon for our patients to avoid taking the opiates entirely after surgery because they don’t have to. However, if they need it, it’s there for them. The practical effect of this approach is that there is less use of these opiate medications.”
Other Reasons to Avoid Opiates
There are other reasons, besides addiction, that these pain medications should be avoided if possible. Dr. Ennin explains.
“The main reason for avoiding opiates is addiction and all of the things that go along with that,” he noted. “The other reason to avoid them is that opiate medications tend to have a poor side-effect profile.”
“Patients who take these opiate-based medications can have issues as small as itching and constipation to as big as nausea. The absolute worst case scenario is where the opiates can cause mental disorientation and hallucinations. The advantage of using our multi-modal pain regimen is that by and large our patients can avoid these side-effects, and even if we need to use them, the amount of medication is less and the side-effects are milder.”
When Joint Replacement is Needed
Dr. Ennin’s practice involves replacing human joints with artificial joints. Typically, a patient begins thinking of undergoing this procedure when their pain is intense. What are the signs that a joint replacement might be helpful?
“What I do is all about quality of life,” he said. “If your quality of life is poor because your knees or your hips hurt, that’s when you should start thinking about joint replacement. If this pain is causing you to miss important events or an outing that you had previously enjoyed because you are afraid of a walk of a few hundred yards, you should seriously consider your alternatives.”
“One of the ways we can help you is by managing your symptoms, rather than operating. The first way we typically approach knee and hip pain is through non-operative pain management. If you have arthritis in some form, we try to manage it without surgery. If this arthritis is so severe that we can’t manage it, that’s when we think of knee or hip replacement.”
Proper pain management, before and after surgery, is very serious and the approaches should be carefully explored. If you would like to discuss your joint pain with a participating physician member, contact us, to schedule an appointment.
Disclaimer: Physicians who are members of the referral program practice independently and are not employees or agents of Texas Health Spine and Orthopedic Center