opioid prescriptions versus those who choose not to
use narcotic pain management due to social, spiritual,
or religious beliefs. Patients who choose to forgo narcotics for perioperative pain management may sacrifice
adequate pain control, resulting in increased length of
stay and higher risk of perioperative morbidity.
opportunity to better understand and educate these
patients may lead to improved pain control, as well
as insight into the unique patient populations that
struggle with the challenge of achieving adequate pain
control postoperatively, particularly when previous
opioid dependence has been an issue.
Opportunities for patient education
As a result of the rise in opioid-associated deaths
and the number of adults regularly using prescription opioid medication, surgeons must now serve as
gatekeepers of iatrogenic opioid dependence, especially considering that surgeons reportedly prescribe
nearly 37 percent of the total opioid pain medication
prescribed to noncancer patients, second only to pain
4, 5 These statistics show that health
care professionals are in a unique position to optimize
pain management strategies that will decrease frequent
and prolonged opioid use. Patient education reportedly
decreases the need for postoperative opioid medication and improves patient satisfaction.
6, 7 Every patient
encounter is a chance to educate patients about pain
management expectations, modalities of pain control,
and the risks of opioid pain medications. Interdisciplinary strategies that incorporate the surgeon, pain
management specialists, nurses, physical and occupational therapists, ancillary staff, families, and other
patient support systems are ideal approaches to controlling patient pain while minimizing opioid use.
Patient education regarding pain control should begin
at the initial clinical evaluation and consultation and
should be reinforced during the preoperative visit.
Patients should be informed about their procedure,
the degree and extent of expected perioperative pain,
recovery time, and expectations for pain management
in the outpatient setting during recovery.
should be counseled to expect adequate pain con-
trol based on function, such as the ability to sleep,
ambulate, and eat. Additionally, patients should be
reminded that zero pain is an unrealistic expectation.
Hill and colleagues recommend setting patient expec-
tations regarding the number of opioid pills that they
will require and subsequently receive to decrease the
number of pills prescribed postoperatively.
education is best provided in a personal, face-to-face
encounter with culturally and linguistically appro-
priate written, video, and web-based educational
The preoperative visit also allows the surgeon to
assess the patient’s history for dependence or tolerance to opioids and previous or current use disorders
that may increase the need for opioid medications in
the postoperative period. For example, patients who
chronically use opioids for long-term pain control
frequently require special attention for controlling
current postsurgical pain and for addressing the continued management of their chronic pain. Some patients
who have struggled with addiction in the past may be
hesitant to use opioids due to fear of recidivism, and
their concerns often require the attention of providers trained in this area of pain management. If such
concern exists, a preoperative visit with the anesthesiologist is warranted to discuss multimodal therapies,
such as nerve blocks, neuraxial anesthesia, and other
alternative pain management strategies.
The postoperative period is when pain control is a priority and is a good time to revisit patient expectations.
Educating patients about their multimodal pain control plan that will include nonopioid medications often
helps in building rapport and establishing more defined
goals for pain management.
13 The postoperative consult is the time to remind patients that eradicating pain
is an unachievable goal and that pain control should be
measured based on their ability to perform activities
of daily living in the postoperative setting. In addition,