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.

As a clinical psychologist, I often have clients say they are having trouble with thoughts “on a loop” in their head, which they find difficult to manage.

While rumination and overthinking are often considered the same thing, they are slightly different (though linked). Rumination is having thoughts on repeat in our minds. This can lead to overthinking – analysing those thoughts without finding solutions or solving the problem.

It’s like a vinyl record playing the same part of the song over and over. With a record, this is usually because of a scratch. Why we overthink is a little more complicated.

We’re on the lookout for threats

Our brains are hardwired to look for threats, to make a plan to address those threats and keep us safe. Those perceived threats may be based on past experiences, or may be the “what ifs” we imagine could happen in the future.

Our “what ifs” are usually negative outcomes. These are what we call “hot thoughts” – they bring up a lot of emotion (particularly sadness, worry or anger), which means we can easily get stuck on those thoughts and keep going over them.

However, because they are about things that have either already happened or might happen in the future (but are not happening now), we cannot fix the problem, so we keep going over the same thoughts.

Who overthinks?

Most people find themselves in situations at one time or another when they overthink.

Some people are more likely to ruminate. People who have had prior challenges or experienced trauma may have come to expect threats and look for them more than people who have not had adversities.

Deep thinkers, people who are prone to anxiety or low mood, and those who are sensitive or feel emotions deeply are also more likely to ruminate and overthink.

Also, when we are stressed, our emotions tend to be stronger and last longer, and our thoughts can be less accurate, which means we can get stuck on thoughts more than we would usually.

Being run down or physically unwell can also mean our thoughts are harder to tackle and manage.

Acknowledge your feelings

When thoughts go on repeat, it is helpful to use both emotion-focused and problem-focused strategies.

Being emotion-focused means figuring out how we feel about something and addressing those feelings. For example, we might feel regret, anger or sadness about something that has happened, or worry about something that might happen.

Acknowledging those emotions, using self-care techniques and accessing social support to talk about and manage your feelings will be helpful.

The second part is being problem-focused. Looking at what you would do differently (if the thoughts are about something from your past) and making a plan for dealing with future possibilities your thoughts are raising.

But it is difficult to plan for all eventualities, so this strategy has limited usefulness.

What is more helpful is to make a plan for one or two of the more likely possibilities and accept there may be things that happen you haven’t thought of.

Think about why these thoughts are showing up

Our feelings and experiences are information; it is important to ask what this information is telling you and why these thoughts are showing up now.

For example, university has just started again. Parents of high school leavers might be lying awake at night (which is when rumination and overthinking is common) worrying about their young person.

Knowing how you would respond to some more likely possibilities (such as they will need money, they might be lonely or homesick) might be helpful.

But overthinking is also a sign of a new stage in both your lives, and needing to accept less control over your child’s choices and lives, while wanting the best for them. Recognising this means you can also talk about those feelings with others.

Let the thoughts go

A useful way to manage rumination or overthinking is “change, accept, and let go”.

Challenge and change aspects of your thoughts where you can. For example, the chance that your young person will run out of money and have no food and starve (overthinking tends to lead to your brain coming up with catastrophic outcomes!) is not likely.

You could plan to check in with your child regularly about how they are coping financially and encourage them to access budgeting support from university services.

Your thoughts are just ideas. They are not necessarily true or accurate, but when we overthink and have them on repeat, they can start to feel true because they become familiar. Coming up with a more realistic thought can help stop the loop of the unhelpful thought.

Accepting your emotions and finding ways to manage those (good self-care, social support, communication with those close to you) will also be helpful. As will accepting that life inevitably involves a lack of complete control over outcomes and possibilities life may throw at us. What we do have control over is our reactions and behaviours.

Remember, you have a 100% success rate of getting through challenges up until this point. You might have wanted to do things differently (and can plan to do that) but nevertheless, you coped and got through.

So, the last part is letting go of the need to know exactly how things will turn out, and believing in your ability (and sometimes others’) to cope.

What else can you do?

A stressed out and tired brain will be more likely to overthink, leading to more stress and creating a cycle that can affect your wellbeing.

So it’s important to manage your stress levels by eating and sleeping well, moving your body, doing things you enjoy, seeing people you care about, and doing things that fuel your soul and spirit.

Distraction – with pleasurable activities and people who bring you joy – can also get your thoughts off repeat.

If you do find overthinking is affecting your life, and your levels of anxiety are rising or your mood is dropping (your sleep, appetite and enjoyment of life and people is being negatively affected), it might be time to talk to someone and get some strategies to manage.

When things become too difficult to manage yourself (or with the help of those close to you), a therapist can provide tools that have been proven to be helpful. Some helpful tools to manage worry and your thoughts can also be found here.

When you find yourself overthinking, think about why you are having “hot thoughts”, acknowledge your feelings and do some future-focused problem solving. But also accept life can be unpredictable and focus on having faith in your ability to cope.

Kirsty Ross, Associate Professor and Senior Clinical Psychologist, Massey University

This article is republished from The Conversation under a Creative Commons license. Read the original article.