Those of us in surgery must do our part to fight the opioid crisis that's killing thousands of Americans every year. Our job is simple: Administer fewer opioids during surgery and discharge patients with a prescription for as low a dose as possible for the shortest time possible. Or with no prescription at all.

We in the surgical community must also recognize that we have unintentionally contributed to the opioid epidemic by overprescribing. Most people who abuse narcotics got their first pills as legitimate prescriptions — oftentimes after surgery or a procedure. But there are virtually no guidelines in place to help anesthesiologists and surgeons choose an appropriate amount for a given procedure or patient. Patients are therefore often prescribed more pills than needed.

Even today, with the addiction and overdose problem showing no signs of abating, many patients are discharged with a prescription for 30 or more prescription painkillers when a fraction of that number will suffice. Nobody needs a prescription for that many Vicodin, hydrocodone or oxycodone for post-surgical pain. Yes, patients should take opioids for the worst pain, but they should only take them for a day or two. There are effective pain management alternatives and many people don't need opioids at all, or at least should drastically reduce the amount they take.

The American Society of Anesthesiologists
National Pain Strategy
asahq.org/NationalPainStrategy

What we're telling patients

Last month, the American Society of Anesthesiolo-gists (ASA) offered patients 5 recommendations for coping with pain and discomfort as they recover from surgery. We're sharing them with you here to reinforce the importance of giving patients the appropriate amount of post-op pain medication.

1 Ask about alternatives. Opioids should be taken only when in extreme pain. Medications such as ibuprofen (Motrin), naproxen (Aleve) and acetaminophen (Tylenol) can effectively manage pain and soreness. While it's never a good idea to rely on any type of pain pills for too long, these medications are not addictive and are far less risky than opioids.

2 Manage your expectations. Everyone feels pain differently, but it's important to realize that soreness and discomfort after surgery are normal and will improve within a day or two. These sensations are less severe than pain, which is usually sharp or intense. Think about when you have your teeth cleaned at the dentist or exercise particularly vigorously. You might be sore afterward but you know it will pass, and wouldn't think of taking an opioid to manage the discomfort. You would likely instead turn to ibuprofen or naproxen to ease the soreness.

3 Be an active participant in your own care. While you're in recovery, the nurse will ask if you're in pain and if so, how much. Be descriptive in explaining how you feel, noting if you are sore, uncomfortable or in serious pain. If you're in major pain, ask that the opioid prescription be written for a small amount, such as 5 pills, as unused pills can fall into the wrong hands. In fact, more than half of the people who misuse prescription painkillers get them from a friend or relative. Keep in mind, while surgical pain can be severe, it is almost always temporary. Your pain will improve significantly within a few days regardless of whether or not you take opioids.

4 Limit the opioids. If you're in severe pain and are prescribed opioids, use them sparingly. Take them only for a day or 2 after surgery, 3 days at most.

5 Be aware of other downsides to opioid use. Opioids cause severe constipation and often don't manage pain as well as people expect. Additionally, they can cause hyperalgesia, meaning they can actually increase sensitivity to pain.

If pain persists

If patients are in continued severe pain after surgery, we recommend that they ask a physician anesthesiologist or pain specialist about other strategies to manage pain, including exercise, nerve blocks and non-opioid medications. OSM