PATIENT INFORMATION
POSTOPERATIVE PAIN MEDICATION
How and when are medications prescribed?
Prescribing opioid medications is no longer a simple task. Every opioid prescription must be entered electronically and is part of the patient's permanent record on E-FORCSE, Florida's secure online system for reporting and monitoring controlled substance prescriptions. (Paper prescriptions and telephone orders are no longer valid in the state of Florida.) Prescription pain medication orders will be sent electronically on the day before your surgery to the pharmacy you selected when registering at Schofield, Hand, and Bright Orthopaedics. Please be aware that not all pharmacies are open 24 hours/day. Additionally, please note that your pharmacy may not contact you when your prescription is ready for pickup. The key takeaway is to plan ahead. Medication issues cannot be resolved with the on-call doctor. Therefore, please call the office during normal business hours if you have any questions or concerns regarding your pain medication.
Which medication is typically prescribed?
Hydrocodone is the medication that is routinely prescribed following hand and upper extremity surgery in this practice. Trade names for this medication include Vicodin, Norco, and Lortab. It is a short-acting opioid medication, commonly used after many medical and dental procedures in the U.S. Your doctor will prescribe the recommended number of pills based on currently available scientific data and years of experience. If you do not want to accept an opioid prescription or have a sensitivity/allergy to this medication (hydrocodone), please make your doctor's office aware of this as soon as possible. Potential side effects of this medication, and other opioids, are discussed below. Alternative pain management strategies include the use of acetaminophen (Tylenol) and/or nonsteroidal anti-inflammatory medications (Motrin, Aleve, etc.). A separate handout clearly explains dosing and intervals regarding non-opioid pain management. Please note that if you take blood-thinning medication, you are not eligible to take anti-inflammatory medications, only Tylenol.
What opioid medications can be prescribed as an alternative to hydrocodone?
Alternative medications that may be offered include tramadol and oxycodone/acetaminophen (Percocet).
What are the potential side effects associated with short-term use of opioid medications?
Side effects include, but are not limited to, nausea, vomiting, constipation, itching, dry mouth, sleepiness, dizziness, impaired thinking skills, and vivid or unusual dreams/nightmares. Contact your surgeon if you experience uncontrolled pain or need assistance with side effects.
How long will I need to take opioid medications following surgery?
First, you may not need opioid medication at all. Many patients can manage postoperative pain with over-the-counter medications such as ibuprofen and Tylenol. When opioids are used, it is commonly for the first 1-2 days only. Many patients switch to OTC medications within a day. For minor procedures such as carpal tunnel release and trigger finger surgery, the average patient will take between 0 and 5 pain pills. As a general rule, take the lowest dose possible for the shortest amount of time.
What is the risk of addiction with the use of postoperative pain medication?
For surgical patients, long-term use and addiction are rare when opioids are used for 5 days or less. If you take opioids for 5 or more days, you may develop tolerance, meaning that over time, you might need higher doses to relieve your pain. You may develop physical dependence. This means your body has gotten used to the opioid medication. You may have withdrawal symptoms as you stop taking the opioids. Common withdrawal symptoms include trouble sleeping, anxiety, irritability, racing heartbeat, and headaches. This is normal; it does not mean you are addicted to the medication. Talk to your doctor if you have withdrawal symptoms.
Can my pain medication be refilled?
Refills on pain medications following surgery are rarely necessary. It is best to have this conversation with your specific provider. The doctor on call (after hours) will not be able to refill your pain prescription. If you believe you will need an additional prescription to "make it through the weekend", please get in touch with your doctor before Friday at 3 PM.
Will pain medication interfere with my other medications?
Unless instructed by your provider, never take opioid pills with antihistamines, sleep aids, sedatives, tranquilizers, or anti-anxiety medications (Xanax, Valium, etc), muscle relaxers, alcohol, or another opioid. Combining these medications with opioids increases your risk of side effects, specifically difficulty breathing.
What else should I know about opioid medication?
Take your medications only as directed by your doctor. Do not share your medication with anyone; sharing your prescriptions is illegal and can endanger other people's health. Do not crush pills. This can speed the rate at which your body absorbs the opioid, causing excessive dosing. Avoid driving or operating heavy machinery while taking opioids.
What happens if I misuse my prescription pain medication?
When misused, prescription medications may be just as dangerous as illegal drugs. Misusing your medications can have serious consequences, including lack of energy, inability to concentrate, physical weakness, nausea, vomiting, and suppressed breathing to the point of death. If you have not taken your medications as directed, and you experience any of the symptoms, please go immediately to an emergency room. If you feel that you have taken more medication than what was prescribed, seek immediate medical attention. Misusing your medications may also lead to addiction; you must take your medications only as prescribed. As you recover from surgery, your opioid use should decrease. If severe pain persists or your opioid requirement increases, please notify your surgeon.
Where should I store my pain pills?
Store prescriptions securely in their original containers. Keep them out of sight and out of children's reach, preferably in a locked cabinet or high shelf.
Additional Resources:
National Institution on Drug Abuse: http://www.drugabuse.gov • Substance Abuse & Mental Health Services Administration: http://oas.samhsa.gov/prescription.htm • FDA recommendations: http://www.fda.gov/Drugs/ResourcesForYou/default.htm