Pain management after surgery for former addict

Tweety, BSN, RN · Dec 13, 2005

My spouse works with impaired nurses in his part time job.

It's important for him to share with his health care provider he's an addict. However, even for addicts narcotic analgesia is necessary. Why should a recovering addict suffer post-op pain? In fact for major surgeries due to tolerances may need more.

I'm sure you're terrified of him returning to his old ways. This doesn't have to be the case. He has to make a committment to take medication only when in pain and stop taking them when he isn't. Maybe even only a one-day supply of pain med rather than 90 pills. Some addicts who are married allow their spouses to dispense the medication.

I really don't have any advise about non-opiate medications. I'm sure there are people here with experience that will help.

Good luck.

Katnip, RN · Dec 13, 2005

Tweety is right. I think even with recovering addicts, the chances of going back to the old ways are very small when narcotics are used for pain control post-procedure.

If you have questions, ask the surgeon. He or she will be able to work with you on this.

luvmy2angels · Dec 13, 2005

I have seen toradol used a lot with former addicts, usually Drs will prescribe a Non narcotic. Depending on the type of hernia that is repaired he may not need a lot of pain meds. A lot of hernia pts can get by with just ibuprofen. Good luck, and I agree with the others that it is very important to share his former habits with the MDs.

zambezi, BSN, RN · Dec 13, 2005

I would also recommend toradol- at least directly post-op (esp. if it is a same day surgery). Of course, there are some other considerations with toradol((allergies to NSAIDS, bleeding issues/ulcers, renal issues)...barring those though, I have seen toradol work fantastically...As for at home pain control...I don't know how well straight tylenol or ibuprophen or something would work...mabye a lower dose narcotic with no refills???

If your husband works with someone who deals with his addiction issues, I would talk about it with them and see what they suggest...If it were a shoulder or something anesthesia could use a block but I don't know if a hernia repair can be covered with a block- it would seem not.

REgardless, I wish you and your husband luck and I hope that his pain can be controlled...

eandgsma · Dec 13, 2005

Thank you for your replies. I will have to (gently) ask my DH to tell his surgeon about his former addiction and what meds are appropriate. I'm glad to know that there are alternatives. The issue of needing even more crossed my mind. If I go with him to his surgical consult, I'll try to bring it up if DH forgets.

Thanks again!

Tenesma · Dec 21, 2005

former addicts have a high risk of relapse even if the drugs are used for post-op pain control.... my recommendation would be

1) a lot of long-acting local anesthetic from the surgeon

2) toradol for 3 days followed by high dose motrin thereafter

3) ultram - a total of 10 pills for bad moments over the first 10 days

4) might want to consider neurontin peri-operatively and post-operatively as that has been shown to decrease total narcotic requirement.

Traveler · Dec 24, 2005

I agree with the previous posters who believe it is important to share the past addiction with the doctor. Abdominal sugery IS a painful surgery and, your DH's tolerance might be lower than the average person because of his history. I just saw an article in one of my nursing journals about a type of morphine that is given in the epidural space that breaks down over 24 hours for constant pain control. It does not require a PCA pump to remain in and the article stated it was used mostly for joint replacement and lower abd. surgery. This might be a good option for your DH. I would try to stay away from regular Oxy/Hydrocodones. Duragesic might be good, but there still is the temptation of messing with the patch. For breakthrough pain I would ask about Actiq and make sure your husband lets you control the dispensing of them. There is no reason for him to hurt and abd. surgery is painful and, as I said before, his tolerance to pain and threshold for meds is probably low/high. Good luck and let us know what the doc. does and how DH does!