Recovering from surgery can be a jittery time—patients expect relief, yet doctors need to guard against overmedication. In my experience, a well‑planned post‑operative pain strategy can improve outcomes, reduce risks, and help patients feel truly supported.
1. Safe and Thoughtful Opioid Prescribing
Opioids can be powerful allies—but only with respect and restraint.
- Start low, go slow: Begin with the lowest effective dose, ideally for the shortest duration. Many common orthopaedic procedures can be managed with a week or less of opioids, especially when combined with non‑opioid pain relief options.
- Consider non‑opioid alternatives first: NSAIDs like ibuprofen and acetaminophen should be the first line. For many patients, these alone offer sufficient relief without opioid risks.
- Double prescription approach: Provide a limited opioid script with clear instructions—and a separate script for non-opioid meds to emphasise usage patterns.
2. Tapering: The Gentle Wean
Abrupt stops can result in rebound pain and distress. Educate patients that tapering is part of recovery.
- Set expectations early: Before they’re discharged, explain the tapering plan. Example: “Take one opioid tablet every 4–6 hours as needed, then stop by day 5. As you improve, drop to every 6–8 hours.”
- Provide a taper schedule: A simple chart—e.g., Day 1–3: 2 tablets/day; Day 4–5: 1 tablet/day—can guide patients and reduce confusion.
- Check in proactively: One or two post‑op calls by the care team ensure they’re not stuck on unnecessary doses or worried about withdrawal.
3. Setting and Managing Patient Expectations
Effective communication reduces anxiety and improves satisfaction.
- Be open about expected pain: It might not be entirely painless, even after a smooth operation. A frank discussion—“you might have some discomfort with movement for a few days”—helps normalize the experience.
- Discuss functional goals: Patients want to know “when can I walk, shower, return to work?” Pain plans should align with these milestones.
- Empower with self‑care tips: Teach icing, elevation, gentle activity, and distraction methods (e.g., breathing exercises, music). These reduce dependence on medications.
4. Team Communication is Key
A unified message from your surgical team, nurses, and GP sets patients up for success.
- Standardised protocols: Having shared opioid taper plans and non‑opioid pathways across the team avoids mixed messages.
- E‑prescribing integration: If the GP can access your discharge plan, opioid refills become safer and decisions more informed.
- Post‑op multidisciplinary reviews: Physiotherapists, pain nurses, and pharmacists can reinforce the taper and track issues early.
Frequently Asked Questions (FAQ)
Q1. How long will I need opioid pain relief after surgery?
Most patients taper off within 5–7 days. Minor orthopaedic procedures—like joint arthroscopies—often require only 3–5 days. Major surgeries may need a week, but the goal is always to taper quickly and safely.
Q2. Is it safe to take ibuprofen and opioids together?
Yes, combining NSAIDs (e.g. ibuprofen) with opioids is common and often recommended. NSAIDs can reduce opioid needs by addressing inflammation and achieving pain control through different mechanisms. Just be cautious in patients with kidney issues or stomach ulcers—alternative analgesics like acetaminophen may be more appropriate.
Q3. What if my pain gets worse when I taper?
Mild rebound pain during tapering is normal, but sharp increases aren’t. If pain intensifies unexpectedly, contact your surgical team—it could be a sign of infection, bleeding, or another complication.
Q4. Can I stop opioids completely on my own?
Under the plan taught at discharge, tapering is patient‑led. But if pain severely worsens or side effects like nausea or mood changes arise, reach out before stopping abruptly. Support is always just a call away.
Q5. Will I get addicted if I take opioids post-surgery?
While any opioid carries addiction risk, short-term, supervised use after surgery has very low addiction rates—especially when patients follow instructions and don’t have a history of substance misuse. Careful prescribing and close follow-up further mitigate risks.
Why This Matters
- Reduces risks: Minimises side effects—constipation, nausea, sedation—and helps avoid prolonged opioid exposure.
- Promotes safer recovery: Non‑opioid alternatives support bone healing and reduce bleeding risk.
- Improves patient confidence: A clear plan keeps anxiety low and motivation high.
- Fosters teamwork: Everyone—from surgeon to GP to physio—is aligned.
