Knee osteoarthritis is a degenerative joint disease that often leads to a total knee replacement. It can cause debilitating pain that prevents people from doing everyday activities like walking and climbing the stairs. While opioids are usually prescribed to manage knee pain or postsurgical pain, patients have recently been seeking alternative options. 

Thankfully, there are innovative non-opioid options. With nearly a million patients a year undergoing total knee replacement surgery, it is critical that patients and providers discuss non-opioid pain management options during their consultation to help manage pain before and after procedures. 

Dr. Matthew Bernard, a board-certified orthopedic surgeon from Southeastern Spine, Brain, and Joint based in Chattanooga, Tennesse, shares his insights on the benefits of non-opioid pain management options: 

What impact do orthopedic surgeons have on prescriptions for pain management? 

Orthopedic surgery can be difficult on the body, and providers want to ensure that patients are experiencing minimal pain before and after their procedure. Unfortunately, many patients receive more potent prescriptions than the CDC recommends. 

In fact, a 2018 report found that nearly two-thirds of surgeons report feeling pressure to prescribe more opioids than they think is necessary. Further, the same report noted that 1 in 4 patients were prescribed extremely high daily doses of opioids and 12% of patients who had a soft tissue or orthopedic procedure reported that they had become addicted to or dependent on opioids following surgery. As an orthopedic surgeon armed with this knowledge, I am passionate about minimizing opioid prescribing as much as possible for my patients.

In recent years, providers have been looking for alternatives to opioids to effectively manage their patients' pain. What prompted you to make a shift in your pain management protocol? 

Opioids prescribed to manage postsurgical pain, even if taken as directed by a provider, are not without risks. These risks include unwanted and potentially severe side effects, as well as the potential for long-term use. To minimize opioid exposure, and to offer alternatives for those in recovery, many providers like myself have been looking for ways to reduce the amount of opioids they prescribe. 

What non-opioid options have you implemented into your practice? 

For patients suffering with knee osteoarthritis, there are alternative pain management methods like physical therapy, non-steroidal anti-inflammatory medications (NSAIDs) like ibuprofen, or non-drug interventions. In my practice, I have been using a form of targeted cold therapy – also known as cryoanalgesia – for patients suffering from knee pain. A  handheld medical device delivers intense targeted cold therapy to specific nerves in the knee and stops pain signals from going to the brain. This offers immediate pain relief. This innovative non-opioid option, which is performed in a doctor's office, effectively manages pain for up to 90 days. 

This option can also help alleviate pain before a total knee replacement so the recovery process following the procedure is more manageable. Patients are also usually exposed to less opioids when using this technique. Incorporating this option into a pain management protocol has allowed me to provide patients a sense of comfort heading into their procedure as they are confident we can manage their pain with little to no opioids. 

How has targeted cold therapy changed the way you view pain management? 

Implementing cryoanalgesia into my pain management protocol has helped reduce opioid use among my knee replacement patients. This is largely because we begin managing their pain before the procedure even begins. I have noticed that my patients are experiencing an overall enhanced surgery and recovery experience. 

The pain relief that targeted cold therapy provides helps my patients get on their feet quicker compared to if they were taking opioids. In my practice, we have also seen that patients treated with cryoanalgesia prior to surgery have a better experience in physical therapy post-op. The use of non-opioids has led to a reduction in pain prior to and following surgery, allowing me to greatly reduce the number of opioids I prescribe. 

Why should providers educate their patients about their non-opioid options? 

When providers educate their patients about all of the available options, it not only helps reduce the number of opioids prescribed but also enhances recovery. 

How should patients start the conversation about pain management with their provider? 

Pain is personal, and all patients experience pain differently. It's imperative for patients to advocate for a pain management plan that's right for them. They should ask their provider about the non-opioid options that are available and how they can work to minimize pain while also eliminating or lessening the need for an opioid prescription. 

For patients looking for more information on pain management options, patient provider discussion guides, and other important pain management information, please visit  www.planagainstpain.com.  

This article is sponsored by Pacira BioSciences, Inc. Dr. Bernard is a consultant of Pacira BioSciences, Inc.