All gain, less pain after abdominal surgery

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Recovering from abdominal surgery is tough. It takes the average person at least six weeks to get back to work.

But a new way to manage pain is getting patients back to work much faster.

The Centers for Disease Control and Prevention says prescription opioid overuse for pain management costs the U.S. at least $78 billion a year.

Steve Milton loves doting on his garden and his dog. But chronic, searing pain in his digestive tract almost kept him from doing either.

"I had a real difficult five months prior to my operation," Milton said.

Three emergency room visits, one hospitalization, never-ending infections are some of what Milton faced.

Doctors put him on antibiotics for diverticulitis.

"They tried a variety of drugs. Actually, had bad reactions to one of the drugs and was hospitalized," he recalled.

Surgery was next with a new way to handle Milton's pain afterward.

"It prevents patients from developing post-operative pain. It accelerates their recovery so they're in bed less and getting less post-operative complications," Cleveland Clinic Akron General Chair of Surgery Dr. Mark Horattas said.

A combination of pain blockers and local anesthetics are placed right next to the incision before surgery. And they last up to three days after the operation, which reduces the need for opioids.

"Opioids were associated with problems with delayed bowel function," Horattas said.

The new approach cut the days in the hospital by more than half and the use of morphine by 80%.

"They feel better, they're happier and they have less pain," Horattas said.

Milton was up and walking around four hours after his surgery, went home in two days and was back at work Monday, only taking Tylenol.

"I'm a new man from what was a real potential life-threatening situation," he said.

According to Horattas, this recovery protocol can be used on all abdominal surgery patients and is being expanded to those going through breast surgery. He hopes to get the protocol approved for all surgeries that require the use of opioids.

Horattas says to talk to your doctor and anesthesiologist about how to manage your pain and prevent it. This is a very serious problem, because nearly 30% of patients prescribed opioids for pain misuse them.

RESEARCH SUMMARY
ALL GAIN LESS PAIN
REPORT #2709

BACKGROUND: Pain Management is a medical approach that draws on disciplines in science and alternative healing to study the prevention, diagnosis, and treatment of pain. A physician who is practicing pain medicine or pain management is usually an anesthesiologist who has been certified or trained on the relief and/or management of pain. A physiatrist may also specialize in pain medicine. Pain management programs can employ massage therapy, analgesic medications, physical therapy, and epidural steroid injections, among others to treat back pain. Pain affects more people in the U.S. than diabetes, heart disease, and cancer combined. Around 126 million, or 55 percent of all adults, experienced pain in the previous three months. Approximately 4 million U.S. adults report "a lot of pain", and 3 million U.S. adults suffer from daily pain. Of those in pain, 27 percent suffer from lower back pain, 15 percent from severe headache or migraine pain, and 15 percent from neck pain. (Source: https://www.spine-health.com/glossary/pain-managementpain-medicine and https://paindoctor.com/resources/chronic-pain-statistics/)

TREATMENTS AND MEDICATIONS: There are a variety of options for the treatment of chronic pain. Oral medications include those that can be taken by mouth, such as nonsteroidal anti-inflammatory drugs, acetaminophen, and opioids. Also available are medications that can be applied to the skin, whether as an ointment or cream or by a patch. Some of these patches work by being placed directly on top of the painful area where the active drug, such as lidocaine, is released. There are many things that may help with your pain which do not involve medications. These things may help relieve some pain and reduce the medications required to control your pain. Examples include exercises, best performed under the direction of a physical therapist. There are also alternative modalities, such as acupuncture. Finally, there are interventional techniques that involve injections into or around various levels of the spinal region. These can involve relatively superficial injections into the painful muscles, called trigger point injections, or may involve more invasive procedures. (Source: https://www.asra.com/page/46/treatment-options-for-chronic-pain)

NEW TARGET FOR CHRONIC PAIN RELIEF: A research team at Hiroshima University is studying a potential new target for chronic pain treatment. Chronic pain mechanisms are complicated, which is one of the reasons why pain management is so difficult, explains Professor Norimitsu Morioka of the Department of Pharmacology, Graduate School of Biomedical & Health Sciences, Hiroshima University. Until now, research has only looked into one type of pain model at a time. Morioka elaborates, "I think it is not enough to reduce by one target. I think it is important to cover a lot of molecules mediating chronic pain, and REV-ERBs seems to be a fitting target. So it is very exciting." The team applied this knowledge to determine if activating the nuclear receptor REV-ERBs in specialized spinal cord cells results in pain relief in mice. Through observations, they concluded the mice did not feel as much pain as the untreated mice with the same type of chronic pain. Based on these results, the researchers believe that this new target for pain relief could benefit many types of chronic pain sufferers. (Source: https://medicalxpress.com/news/2019-03-chronic-pain-relief-scientists.html)