“An ounce of prevention is worth a pound of cure”
– Benjamin Franklin
Coordinating Post-Operative Pain Management with the Surgeon or Dentist
Aside from concerns regarding impairment or loss of function after surgery, most people’s primary concern for surgery revolves around pain and it’s effective management. The best way to assure optimal post-operative pain management is to facilitate the coordination of your care between your surgeon or dentist and your pain management physician – see below.
see also:
Definitions and Terms Related to Pain
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Coordinating Post-Operative Pain Management with the Surgeon or Dentist
Planning for Management of Post-Operative Pain
When you plan to have surgery, including orthopedic or dental procedures, it is best to plan ahead. These special circumstances require appropriate communication between both you and the surgeon or dentist as well as your pain management physician. Dr. Ehlenberger is working on establishing a protocol or recommendations to communicate to the surgeon to optimize post-operative pain management. Please discuss this with him as soon as posssible before planned surgery.
There are medical and pharmacologic implications that are significant in this situation. Most importantly, the anesthesiologist and surgeon must be completely aware of your current medications in order to safely dose anesthetics during the surgical procedure and to be able to more accurately predict your post-operative pain medication needs. Without knowing your tolerance and experience with pain medications, the surgeon may under-dose your pain medications and provide inadequate relief of your pain.
Additionally, there are things you can do to reduce the amount of pain in the immediate post-op period but also to reduce the likelihood of your post-op pain from becoming chronic. Your pain management physician can discuss these considerations with your surgeon to optimize your pain outcome. This process is best initiated weeks before the date of your surgery.
See: Surgical Pain, Post-Operative
The regulations governing patients in the chronic opioid pain management setting may restrict patients to being prescribed medications only by their pain management physician unless alternative plans are made. Because surgeons may be uncomfortable or lack the knowledge for prescribing post-operative pain medications in this setting, it is best to initiate communication with both your surgeon and your pain management physician well before surgery. First, notify your pain management physician ASAP of any upcoming surgery to discuss your two options:
Option 1
Your pain management physician may then arrange for your surgeon to take over responsibility for managing your post-operative pain, including writing your pain prescriptions for the days or weeks following your surgery. When the surgeon feels the time is appropriate, he can then provide your pain management physician with a final post-operative report of your condition and transfer back the responsibility for chronic pain management as indicated to the pain management physician. The advantages to having the surgeon manage post-op pain include the surgeon’s intimate knowledge of the pain expected to be associated with a certain procedure, usual close post-op follow-up appointments and the potential for restricted travel in the post-op period that may limit access to your pain management physician.
Option 2
When a surgical procedure is not expected to restrict travel or access to your pain management physician, the post-op pain can be managed directly by the pain management physician. The advantage of this option is that it allows for continuity of care from the physician with the most intimate knowledge of your pain and your history of pain medications.
Buprenorphine (Butrans, Belbuca, Suboxone, Zubsolv, Bunavail)
Because of the special pharmacologic characteristics of buprenorphine, special attention must be taken to plan for post-operative pain management for those patients taking buprenorphine.
See: Buprenorphine – Emergency & Surgical Pain Management
Unplanned and E
mergency Surgery/Surgical Procedures
Even when the circumstances are such that it is not possible to advise your pain management physician before a surgery or procedure, it is still the responsibility of the patient to fully inform the surgeon of their chronic pain management circumstances.
Please inform your pain management physician as soon as you are able to do so when planning any surgical or dental procedure so that he can assist you in meeting your pain management needs. Failure to do so may result in both medical and regulatory pitfalls that could otherwise be easily avoided.
Emphasis on Education
Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.
For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.
Please note also, that many of the benefits for medications described on this web site include “off-label” use for a medication. Off-label prescribing refers to the use of medication for a condition not named in its FDA approval. Physicians are free to prescribe any medication they want, as long as there is some evidence for usefulness. And remember that the lack of an FDA indication does not necessarily mean lack of efficacy—it sometimes means that no drug company has deemed the investment in clinical trials worth the eventual pay off.
Should you wish more information regarding any of the subjects listed – or not listed – here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.
For more information, please contact Accurate Clinic.
Supplements recommended by Dr. Ehlenberger may be purchased commercially online or at Accurate Clinic.
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