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Fixing young joints without opioids for pain relief

Fixing young joints without opioids for pain relief

Brandon Vaughn and Carter Flory, Chambersburg High School football teammates, both had surgery on the same day last fall to repair torn ligaments in their knees. 

WellSpan orthopedic surgeon Dr. Michael Day did not prescribe opioids for either teen after the surgery. Instead, Day prescribed a medicine that decreases inflammation, a nerve medication, over-the-counter Tylenol and the use of an ice machine for pain control after the surgery. 

Day recently began foregoing prescribing opioids for all his patients under the age of 25 after orthopedic surgery, with an eye toward reducing the exposure of patients and families to narcotic drugs in light of the country's opioid crisis. 

"Eliminating opioids after surgery is definitely a trend and a push in orthopedics in general," Day said. "Most patients have some pain the first couple of days. We tell them to expect that, and it will be manageable." 

Across the system, WellSpan  surgeons, nurses, and anesthesiologists work as a team to offer effective, safe, post-surgical pain control, replacing the use of opioids with other treatments. Since 2019, WellSpan clinicians have focused those efforts on cesarean sections, hernia repairs, gallbladder surgeries, spinal fusions, and total knee and total hip replacements. For those procedures, WellSpan's team has decreased opioid use by 46 percent since 2019, a decrease equivalent to more than 141,000 5 mg oxycodone tablets now not being prescribed. 

Both the teens' mothers were grateful for Day's opioid-free approach. 

Brandon's mother, Penny, had been prescribed oxycodone, an opioid, following a dental procedure and another surgery and did not like the way it made her feel. Carter's mother, Hillary, had worked in registration at a Maryland hospital emergency room and saw the results of opioid addiction in patients both seeking opioids or suffering an overdose from their use. 

"When Dr. Day said Carter would not have the opioid painkillers prescribed after surgery, I said, 'I'm fine with that!' " Hillary said. 

Brandon, 18, and Carter, 17 (who later underwent a second surgery due to the extent of his ligament tears), both had some pain and a few uncomfortable days after their surgeries but the ice machine and the Tylenol helped. They also began physical therapy at WellSpan Results Fitness in Chambersburg promptly after their operations, which helped them to get on their feet again. 

"I'm doing everything now," Brandon says. "I feel like I'm back to normal. The only reminder I had from the surgery is the scar. I'm glad I got through it without having to use opioids." 

About a year ago, Day first began foregoing opioid prescriptions for patients under the age of 25 undergoing a repair of a torn anterior cruciate ligament (ACL), a key ligament in the knee joint that is at risk of tears in athletes who do start-and-stop movements in sports including football, soccer, and basketball. Seeing the success of that, Day extended the practice to all ACL patients and then to all orthopedic patients under the age of 25, including those who undergo shoulder or kneecap stabilization surgery, among other procedures. 

Day used to routinely prescribe 30 opioid pills to patients for pain control after surgery. He then started tracking how many of those pills patients took and found it was less than half, so he reduced his prescriptions to just 15 pills. He noticed teens took even fewer pills, maybe just one for the first therapy session and none after that. 

"They would realize they didn't really need it," he said. "They were taking really low numbers and probably just because it was prescribed, not because they really needed it. And they are at the highest risk for exposure to something that could later be an addictive medication. 

"I figured if we could eliminate that and have an equivalent pain control, that was a good idea." 

Day tells patients if their pain feels unmanageable, they can call him for help and a stronger prescription. But during the past year, no one has called. 

"A lot of people are strongly in favor of avoiding opioids," he says. "There is an awareness of how problematic opioids have been for our society, and a lot of people are happy not to introduce them in their care." 

Learn more about WellSpan orthopedic care here.