I’ve been given opioids after surgery to take at home. What do I need to know?
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Opioids are commonly prescribed when you’re discharged from hospital after surgery to help manage pain at home.
These strong painkillers may have unwanted side effects or harms, such as constipation, drowsiness or the risk of dependence.
However, there are steps you can take to minimise those harms and use opioids more safely as you recover from surgery.
Which types of opioids are most common?
The most commonly prescribed opioids after surgery in Australia are oxycodone (brand names include Endone, OxyNorm) and tapentadol (Palexia).
In fact, about half of new oxycodone prescriptions in Australia occur after a recent hospital visit.
Most commonly, people will be given immediate-release opioids for their pain. These are quick-acting and are used to manage short-term pain.
Because they work quickly, their dose can be easily adjusted to manage current pain levels. Your doctor will provide instructions on how to adjust the dosage based on your pain levels.
Then there are slow-release opioids, which are specially formulated to slowly release the dose over about half to a full day. These may have “sustained-release”, “controlled-release” or “extended-release” on the box.
Slow-release formulations are primarily used for chronic or long-term pain. The slow-release form means the medicine does not have to be taken as often. However, it takes longer to have an effect compared with immediate-release, so it is not commonly used after surgery.
Controlling your pain after surgery is important. This allows you get up and start moving sooner, and recover faster. Moving around sooner after surgery prevents muscle wasting and harms associated with immobility, such as bed sores and blood clots.
Everyone’s pain levels and needs for pain medicines are different. Pain levels also decrease as your surgical wound heals, so you may need to take less of your medicine as you recover.
But there are also risks
As mentioned above, side effects of opioids include constipation and feeling drowsy or nauseous. The drowsiness can also make you more likely to fall over.
Opioids prescribed to manage pain at home after surgery are usually prescribed for short-term use.
But up to one in ten Australians still take them up to four months after surgery. One study found people didn’t know how to safely stop taking opioids.
Such long-term opioid use may lead to dependence and overdose. It can also reduce the medicine’s effectiveness. That’s because your body becomes used to the opioid and needs more of it to have the same effect.
Dependency and side effects are also more common with slow-release opioids than immediate-release opioids. This is because people are usually on slow-release opioids for longer.
Then there are concerns about “leftover” opioids. One study found 40% of participants were prescribed more than twice the amount they needed.
This results in unused opioids at home, which can be dangerous to the person and their family. Storing leftover opioids at home increases the risk of taking too much, sharing with others inappropriately, and using without doctor supervision.
How to mimimise the risks
Before using opioids, speak to your doctor or pharmacist about using over-the-counter pain medicines such as paracetamol or anti-inflammatories such as ibuprofen (for example, Nurofen, Brufen) or diclofenac (for example, Voltaren, Fenac).
These can be quite effective at controlling pain and will lessen your need for opioids. They can often be used instead of opioids, but in some cases a combination of both is needed.
Other techniques to manage pain include physiotherapy, exercise, heat packs or ice packs. Speak to your doctor or pharmacist to discuss which techniques would benefit you the most.
However, if you do need opioids, there are some ways to make sure you use them safely and effectively:
- ask for immediate-release rather than slow-release opioids to lower your risk of side effects
- do not drink alcohol or take sleeping tablets while on opioids. This can increase any drowsiness, and lead to reduced alertness and slower breathing
- as you may be at higher risk of falls, remove trip hazards from your home and make sure you can safely get up off the sofa or bed and to the bathroom or kitchen
- before starting opioids, have a plan in place with your doctor or pharmacist about how and when to stop taking them. Opioids after surgery are ideally taken at the lowest possible dose for the shortest length of time.
If you’re concerned about side effects
If you are concerned about side effects while taking opioids, speak to your pharmacist or doctor. Side effects include:
- constipation – your pharmacist will be able to give you lifestyle advice and recommend laxatives
- drowsiness – do not drive or operate heavy machinery. If you’re trying to stay awake during the day, but keep falling asleep, your dose may be too high and you should contact your doctor
- weakness and slowed breathing – this may be a sign of a more serious side effect such as respiratory depression which requires medical attention. Contact your doctor immediately.
If you’re having trouble stopping opioids
Talk to your doctor or pharmacist if you’re having trouble stopping opioids. They can give you alternatives to manage the pain and provide advice on gradually lowering your dose.
You may experience withdrawal effects, such as agitation, anxiety and insomnia, but your doctor and pharmacist can help you manage these.
How about leftover opioids?
After you have finished using opioids, take any leftovers to your local pharmacy to dispose of them safely, free of charge.
Do not share opioids with others and keep them away from others in the house who do not need them, as opioids can cause unintended harms if not used under the supervision of a medical professional. This could include accidental ingestion by children.
For more information, speak to your pharmacist or doctor. Choosing Wisely Australia also has free online information about managing pain and opioid medicines.
Katelyn Jauregui, PhD Candidate and Clinical Pharmacist, School of Pharmacy, Faculty of Medicine and Health, University of Sydney; Asad Patanwala, Professor, Sydney School of Pharmacy, University of Sydney; Jonathan Penm, Senior lecturer, School of Pharmacy, University of Sydney, and Shania Liu, Postdoctoral Research Fellow, Faculty of Medicine and Dentistry, University of Alberta
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Endure – by Alex Hutchinson
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Life is a marathon, not a sprint. For most of us, at least. But how do we pace ourselves to go the distance, without falling into complacency along the way?
According to our author Alex Hutchinson, there’s a lot more to it than goal-setting and strategy.
Hutchinson set out to write a running manual, and ended up writing a manual for life. To be clear, this is still mostly centered around the science of athletic endurance, but covers the psychological factors as much as the physical… and notes how the capacity to endure is the key trait that underlies great performance in every field.
The writing style is both personal and personable, and parts read like a memoir (Hutchinson himself being a runner and sports journalist), while others are scientific in nature.
As for the science, the kind of science examined runs the gamut from case studies to clinical studies. We examine not just the science of physical endurance, but the science of psychological endurance too. We learn about such things as:
- How perception of ease/difficulty plays its part
- What factors make a difference to pain tolerance
- How mental exhaustion affects physical performance
- What environmental factors increase or lessen our endurance
- …and many other elements that most people don’t consider
Bottom line: whether you want to run a marathon in under two hours, or just not quit after one minute forty seconds on the exercise bike, or to get through a full day’s activities while managing chronic pain, this book can help.
Click here to check out Endure, and find out what you are capable of when you move your limits!
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The Plant-Based Athlete – by Matt Frazier and Robert Cheeke
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If you’re already a seasoned plant-based athlete yourself, you can probably skip this book; the 60 recipes at the end would still provide value, but there is the “No Meat Athlete Cookbook” that you could hop straight to, in any case.
For most readers, there will be plenty of value from start to finish. We get a quick ground-up tour of nutrition basics, before getting into restructuring diet to optimize it for performance.
There is less in the way of “Vegans struggle with…” and more in the way of “People think vegans struggle with…” and explanations of what vegan athletes actually eat. The book does include science, but isn’t too science-heavy, and relies more on modelling what plant-based superathletes enjoy on a daily basis.
To that end,if the book has a weak point, it’s perhaps that it could have stood to include more science. The book comes recommended by Dr. Michael Greger, whose nutritional approach is incredibly science-heavy and well-referenced, and this book is obviously compatible with that (so they could have!), but in this case Frazier and Cheeke leave us to take their word for it.
Nevertheless, the science is good whether they cite it or not, and this book is quite a comprehensive primer of plant-based athleticism.
Bottom line: if you’re wondering how to optimize the two goals of “eating plants” and “being a powerful athlete”, then this one’s the book for you.
Click here to check out The Plant-Based Athlete and upgrade your health and athletic performance!
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Parent Effectiveness Training – by Dr. Thomas Gordon
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Do you want your home (or workplace, for that matter) to be a place of peace? This book literally got the author nominated for a Nobel Peace Prize. Can’t really get much higher praise than that.
The title is “Parent Effectiveness Training”, but in reality, the advice in the book is applicable to all manner of relationships, including:
- romantic relationships
- friends
- colleagues
- …and really any human interaction.
It covers some of the same topics we did today (and more) in much more detail than we ever could in a newsletter. It lays out formulae to use, gives plenty of examples, and/but is free from undue padding.
- Pros: this isn’t one of those “should have been an article” books. It has so much valuable content.
- Cons: It is from the 1970s* so examples may feel “dated” now.
In addition to going into much more detail on some of the topics covered in today’s issue of 10almonds, Dr. Gordon also talks in-depth about the concept of “problem-ownership”.
In a nutshell, that means: whose problem is a given thing? Who “has” what problem? Everyone needs to be on the same page about everyone else’s problems in the situation… as well as their own, which is not always a given!
Dr. Gordon presents, in short, tools not just to resolve conflict, but also to pre-empt it entirely. With these techniques, we can identify and deal with problems (together!) well before they arise.
Everybody wins.
Get your copy of “Parent Effectiveness Training” from Amazon today!
*Note: There is an updated edition on the market, and that’s what you’ll find upon following the above link. This reviewer (hi!) has a battered old paperback from the 1970s and cannot speak for what was changed in the new edition. However: if the 70s one is worth more than its weight in gold (and it is), the new edition is surely just as good, if not better!
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Get Past Executive Dysfunction
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In mathematics, there is a thing called the “travelling salesman problem”, and it is hard. Not just subjectively; it is classified in mathematical terms as an “NP-hard problem”, wherein NP stands for “nondeterministic polynomial”.
The problem is: a travelling salesman must visit a certain list of cities, order undetermined, by the shortest possible route that visits them all.
To work out what the shortest route is involves either very advanced mathematics, or else solving it by brute force, which means measuring every possible combination order (which number gets exponentially larger very quickly after the first few cities) and then selecting the shortest.
Why are we telling you this?
Executive dysfunction’s analysis paralysis
Executive dysfunction is the state of knowing you have things to do, wanting to do them, intending to do them, and then simply not doing them.
Colloquially, this can be called “analysis paralysis” and is considered a problem of planning and organizing, as much as it is a problem of initiating tasks.
Let’s give a simple example:
You wake up in the morning, and you need to go to the bathroom. But the bathroom will be cold, so you’ll want to get dressed first. However, it will be uncomfortable to get dressed while you still need to use the bathroom, so you contemplate doing that first. Those two items are already a closed loop now. You’re thirsty, so you want to have a drink, but the bathroom is calling to you. Sitting up, it’s colder than under the covers, so you think about getting dressed. Maybe you should have just a sip of water first. What else do you need to do today anyway? You grab your phone to check, drink untouched, clothes unselected, bathroom unvisited.
That was a simple example; now apply that to other parts of your day that have much more complex planning possible.
This is like the travelling salesman problem, except that now, some things are better if done before or after certain other things. Sometimes, possibly, they are outright required to be done before or after certain other things.
So you have four options:
- Solve the problem of your travelling-salesman-like tasklist using advanced mathematics (good luck if you don’t have advanced mathematics)
- Solve the problem by brute force, calculating all possible variations and selecting the shortest (good luck getting that done the same day)
- Go with a gut feeling and stick to it (people without executive dysfunction do this)
- Go towards the nearest item, notice another item on the way, go towards that, notice a different item on the way there, and another one, get stuck for a while choosing between those two, head towards one, notice another one, and so on until you’ve done a very long scenic curly route that has narrowly missed all of your targetted items (this is the executive dysfunction approach).
So instead, just pick one, do it, pick another one, do it, and so forth.
That may seem “easier said than done”, but there are tools available…
Task zero
We’ve mentioned this before in the little section at the top of our daily newsletter that we often use for tips.
One of the problems that leads to executive function is a shortage of “working memory”, like the RAM of a computer, so it’s easy to get overwhelmed with lists of things to do.
So instead, hold only two items in your mind:
- Task zero: the thing you are doing right now
- Task one: the thing you plan to do next
When you’ve completed task zero, move on to task one, renaming it task zero, and select a new task one.
With this approach, you will never:
- Think “what did I come into this room for?”
- Get distracted by alluring side-quests
Do not get corrupted by the cursed artefact
In fantasy, and occasionally science fiction, there is a trope: an item that people are drawn towards, but which corrupts them, changes their motivations and behaviors for the worse, as well as making them resistant to giving the item up.
An archetypal example of this would be the One Ring from The Lord of the Rings.
It’s easy to read/watch and think “well I would simply not be corrupted by the cursed artefact”.
And then pick up one’s phone to open the same three apps in a cycle for the next 40 minutes.
This is because technology that is designed to be addictive hijacks our dopamine processing, and takes advantage of executive dysfunction, while worsening it.
There are some ways to mitigate this:
Rebalancing Dopamine (Without “Dopamine Fasting”)
…but one way to avoid it entirely is to mentally narrate your choices. It’s a lot harder to make bad choices with an internal narrator going:
- “She picked up her phone absent-mindedly, certain that this time it really would be only a few seconds”
- “She picked up her phone for the eleventy-third time”
- “Despite her plan to put her shoes on, she headed instead for the kitchen”
This method also helps against other bad choices aside from those pertaining to executive dysfunction, too:
- “Abandoning her plan to eat healthily, she lingered in the confectionary aisle, scanning the shelves for sugary treats”
- “Monday morning will be the best time to start my new exercise regime”, she thought, for the 35th week so far this year
Get pharmaceutical or nutraceutical help
While it’s not for everyone, many people with executive dysfunction benefit from ADHD meds. However, they have their pros and cons (perhaps we’ll do a run-down one of these days).
There are also gentler options that can significantly ameliorate executive dysfunction, for example:
Bacopa Monnieri: A Well-Evidenced Cognitive Enhancer For Focus & More
Enjoy!
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Beat Sugar Addiction Now! – by Dr. Jacob Teitelbaum & Chrystle Fiedler
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Sugar isn’t often thought of as an addiction in the same category as alcohol or nicotine, but it’s actually very similar in some ways…
A bold claim, but: in each case, it has to do with dopamine responses to something that has:
- an adverse effect on our health,
- a quickly developed tolerance to same,
- and unpleasant withdrawal symptoms when quitting.
However, not all sugar addictions are created equal, and Dr. Teitelbaum lays four different types of sugar addiction out for us:
- Most related to “I need to perform and I need to perform now”
- Most related to “I just need something to get me through one more stressful day, again, just like every day before it”
- Most related to “ate too much sugar because of the above, and now a gut overgrowth of C. albicans is at the wheel”
- Most related to “ate too much sugar because of the above, and now insulin resistance is a problem that perpetuates itself too”
Of course, these may overlap, and indeed, they tend to stack cumulatively as time goes by.
However, Dr. Teitelbaum notes that as readers we may recognize ourselves as being at a particular point in the above, and there are different advices for each of them.
You thought it was just going to be about going cold turkey? Nope!
Instead, a multi-vector approach is recommended, including adjustments to sleep, nutrition, immune health, hormonal health, and more.
In short: if you’ve been trying to to kick the “White Death” habit as Gloria Swanson called it (sugar, that is, not the WW2 Finnish sniper of the same name—we can’t help you with that one), then this book is really much more helpful than others that take the “well, just don’t eat it, then” approach!
Pick up your copy of Beat Sugar Addiction Now from Amazon, and start your journey!
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Meals That Heal – by Dr. Carolyn Williams
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Inflammation is implicated as a contributory or casual factor in almost all chronic diseases (and still exacerbates the ones in which it’s not directly implicated causally), so if there’s one area of health to focus on with one’s diet, then reducing inflammation is a top candidate.
This book sets about doing exactly that.
You may be wondering whether, per the book’s subtitle, they can really all be done in 30 minutes or under. The answer is: no, not unless you have a team of sous-chefs to do all the prep work for you, and line up everything mise-en-place style for when you start the clock. If you do have that team of sous-chefs working for you, then you can probably do most of them in under 30 minutes. If you don’t have that team, then budget about an hour in total, sometimes less, sometimes more, depending on the recipe.
The recipes themselves are mostly Mediterranean-inspired, though you might want to do a few swaps where the author has oddly recommended using seed oils instead of olive oil, or plant milk in place of where she has used dairy milk in a couple of “recipes” for smoothies. You might also want to be a little more generous with the seasonings, if you’re anything like this reviewer.
Bottom line: if you’re looking for an anti-inflammatory starter cookbook, you could do worse than this. You could probably do better, too, such as starting with The Inflammation Spectrum – by Dr. Will Cole.
Alternatively, click here if you want to check out Meals That Heal, and dive straight in!
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