Beating the Opioid Epidemic with Multimodal Pain Control

istock 879167778As most patient and physicians have heard by now, we are in the midst of an opioid epidemic. Providers and pharmacies are doing their best to limit opioid prescriptions, due to dangers of addiction as well as the side effects. In many ways, opioids can hinder the post-operative rehabilitation effort. Opioids cause sedation as well as other side effects, which limit participation in physical therapy as well as deep breathing. This can lead to a multitude of issues during the post-operative course, including muscular atrophy/deconditioning, as well as pneumonia.

To find the optimal way to achieve post-operative pain control, many of us have recently started championing a multi-modal approach. This includes using multiple non-narcotic pain medications, each with a different mechanism of action. Each utilized medication targets different pain receptors. Studies have shown that this approach actually has a synergistic effect on pain control, in which the total pain relief is superior to the sum of the parts.

A combination that has gained recent traction is celecoxib and a gabapentinoid (either pregabalin or gabapentin). Celecoxib is a powerful anti-inflammatory; however, it is a selective anti-inflammatory and thus does not have deleterious effects on wound and bone healing after fusions. Gabapentin and pregabalin are powerful nerve pain medications. Studies have shown significant decrease in opioid requirements post-operatively when a multimodal pain regimen is utilized.

I am an advocate for using both celecoxib and gabapentin post-operatively. This has allowed us to decrease the amount of narcotic medications that our patients require. The end result is a quicker and safer post-operative experience that gets the patient functional and back to doing the things they love!

If you are interested in learning more about Multimodal Pain Control, contact us at (916) 352-0016 or fill out a Contact Form here.

Here is a list of relevant literature if you would like to read more about this topic:

Peng C, Li C, Qu J, Wu D. Gabapentin can decrease acute pain and morphine consumption in spinal surgery patients: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017;96(15):e6463. doi:10.1097/MD.0000000000006463

Liu B, Liu R, Wang L. A meta-analysis of the preoperative use of gabapentinoids for the treatment of acute postoperative pain following spinal surgery. Medicine (Baltimore). 2017;96(37):e8031. doi:10.1097/MD.0000000000008031

Posted in: Multimodal Pain Control

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Due to the ongoing epidemic of the novel coronavirus (COVID-19), Sierra Spine Institute has elected to proceed with measures to protect the safety of our patients, our staff, and our community.

We have instituted minimal visits in our physical office in order to promote social distancing and minimize the chance of spreading this contagion in our community. While we will continue to evaluate urgent patient care issues in our physical office, we are moving the majority of our patient visits to online platforms in order to ensure the safety of our patients, staff, and community.

If you are a new or established patient to our practice, our staff will reach out to you prior to your appointment date in order to confirm your appointment and help you set-up the online platform to proceed with the appointment. If you do require an evaluation in our physical office, our staff will help coordinate a date and time that works for you to ensure minimal patient flow through the office. Our phone lines and answering service will continue uninterrupted, and we will continue to have a physician on call 24/7 to address any urgent care needs.

Currently, Sutter Roseville Medical Center and Sutter Surgical Hospital North Valley have postponed all elective cases up to 4/10/2020. Elective surgeries beyond this date are being evaluated on a week-by-week basis.

Please read our full statement by clicking the link below.

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