QUESTION: I’m getting a knee replacement soon, and I’m worried about getting hooked on pain meds following the surgery — withdrawal is awful. It’s happened to me before.
Are there any new treatments for opioid withdrawal?
— Cassie F., Hillsdale, Fla.
ANSWER: Two things you need to do right away are: 1) get in touch with a pain management specialist, especially if you’ve been addicted to opioids before; and 2) ask your orthopedic surgeon about getting regional (in this case, the knee) anesthetics during the operation that let you wake up without (so much) pain. They may make other pain meds unnecessary (or far less necessary) post-op.
Withdrawal symptoms can include anxiety, agitation, sleep problems, muscle aches, sweating, nausea, diarrhea and drug craving. And, says the Food and Drug Administration, “these symptoms … occur both in patients who have been using opioids appropriately as prescribed and in patients with opioid use disorder.”
But with wise pain management including the regional anesthetics, nonopioid pain relievers, physical therapy, following an anti-inflammatory Mediterranean diet and practicing stress management techniques before and after surgery, you may be able to avoid the addiction/withdrawal problem completely.
If not, there are two newly available medications that can make withdrawal from opioids less grueling.
There’s a recently FDA- approved generic version of the opioid-based (and potentially addictive) buprenorphine-naloxone film. That should make this remedy more widely available and less expensive. There’s also lofexidine, a nonopioid treatment that reduces the release of norepinephrine, a neurotransmitter that is thought to play a role in many of the symptoms of opioid withdrawal.
Although it has been around for 20 to 25 years in the U.K., it just received FDA approval. It provides a 14-day treatment. Both meds work about 40 percent of the time, but hopefully you won’t need to try them.
Potential aids: Just last year the FDA granted marketing authorization of the first electro-stimulating ear device to help reduce the symptoms of opioid withdrawal (Innovative Health Solutions’ NSS-2 Bridge), and now there’s another player in the market, the auricular (outer ear) neuro-stimulator (Drug Relief, by DyAnsys, Inc.).
These are both a little pricey and may or may not have solid science behind them, but even a placebo works three out of 10 times.