opioids

MANKATO — The national opioid epidemic has hospitals and clinics focusing on more patient education and tighter guidelines on how physicians prescribe narcotics for pain.

"It's a challenging topic. We've really embraced that to take on this national crisis," said Dr. Brian Bartlett, vice chief medical officer for hospital specialties at Mayo Clinic Health System in Mankato.

Dr. Andrew Lundquist, a foot and ankle surgeon and chief medical officer at Mankato Clinic, said the medical profession has done an abrupt turnaround from years ago when the dangers of addiction and death from opioids was not understood.

"We've come full circle. In 2001 pain was called the Fifth Vital Sign and we were aggressively treating pain with all measures. Now we found there are unintended consequences.

"We all take the Hippocratic Oath of 'do no harm,' " he said.

"More communication with patients is good and helps outcomes because everyone is on the same page," Lundquist said.

Both physicians said reducing dependency risk from opioids, particularly after surgeries, is not as simple as requiring that every patient only be on narcotics for a specific number of days.

"We know each operation is different and the degree of pain and length of time is going to be different, so a one-size policy doesn't work for our patients," Bartlett said.

The healthcare facilities follow recent CDC guidelines for opioid use.

"Three days and no more than one week is recommended when they're needed. That is specific to the emergency departments," Bartlett said.

"After acute illness or an operation, if patients are truly requiring pain control after three to seven days then we want to re-evaluate that patient to make sure nothing else is going on and that they're being treated properly, and we want to explore other options for pain."

Lundquist said it's important for doctors to be up front with patients that some pain comes with surgery.

"I'm a surgeon and I counsel my patients more on the fact they will have some pain after surgery and that's expected and normal. We aren't trying to go completely pain-free, but we are trying to get down to a level where it's comfortable," Lundquist said.

Beyond surgeries, getting the right balance for patients who have chronic pain can be difficult. Doctors and patients want to limit ongoing pain, but ensure people don't become addicted to opioid pain medicine.

Both doctors said their facilities are turning more to alternative ways to limit pain.

"Using Tylenol, ibuprofen and other pain relievers, massage therapy, physical therapy, are also very effective in controlling pain and are safer," Bartlett said. "We use a multifaceted approach to pain relief."

Lundquist said they also have a program in Mankato Clinic's physical therapy program to use non-opioid ways to reduce pain. "And Advance Pain Management is a partner that works with us on injections and other non-opioid measures."

He said that many patients do try to avoid narcotics for pain.

"Anecdotally, with my patients, I'll give them ibuprofen and Tylenol and a narcotic after surgery and a significant number will try to use ibuprofen and Tylenol only and have good results. It depends on the procedure and the patients. Opioids are not the only solution for pain."

Follow Tim Krohn on Twitter @TimKrohn

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