How can athletes avoid pain and addiction post-surgery?
As a sports-neurologist
and pain medicine specialist, I have specific expertise in the management
of chronic pain in athletes. Unfortunately, with this expertise, I bear
too-frequent witness to the dual-heartbreak of athletes who experience
a season- or career-halting injury and subsequent surgery, only to have
it be accompanied by pain and opioid addiction. Thankfully, recent and
crucial research examines this actual and dangerous occurrence in athletes
at all levels of play. What this clinical study uncovers helps researchers
shed light on specific problems. At the same time, it illuminates alternatives
so that athletes can heal, recover, and return to the game or return to
living a life free from pain and addiction.
First, I must note that despite our focus on the COVID pandemic, opioid
addiction in the United States remains a significant problem faced by
people who engage in sports, as well as those who don't. The reasons
for the addiction are as unique as the people who are taking this class
of medications – whether the medicines are prescribed or obtained
illicitly. I carve out the athletic population from others because I believe
it is essential to observe this group's uniqueness – in the
hopes that we may be able to learn from and help to prevent pain from
substance abuse that turns into addiction.
For most athletes who have undergone reparative surgery for a sports injury,
some form of pain relief is often necessary. Historically, common prescriptions
for post-surgical pain have come in the form of an opioid. And this is
mainly because many prescribing physicians learned in medical school that
adequate pain relief is achievable only by prescribing one of these powerful
opioid drugs. But today, new research is bringing alternatives to the
forefront. Indeed, appropriate pain relief can be achieved for post-surgical
pain with a variety of non-opioid pain relievers and other non-medication
strategies. Some medication alternatives include anti-inflammatories,
nerve pain interceptors, and adjuvants to reduce muscle tension or spasticity
associated with guarding.
While there may remain cases where an athlete's pain should be managed
with an opioid – reliable and effective alternatives allow physicians
to minimize use of opioid medications. In some instances, we can even
try a less risky option first and then switch to an opioid
if the pain is still not properly managed. That is a huge win for patients.
We also have tools to help athletes (and other people in pain) overcome
pain with options that don't involve medication therapy. I've
written extensively on and wholeheartedly believe in highly effective
non-medication strategies for pain management. Non-medication strategies
include neuromodulation (applying a stimulus such as focused cold, electrical
or magnetic energy to nerves that reduces pain), as well as manual therapies
like massage, regional cryotherapy, and even mindfulness meditation or
virtual reality sessions that quiet the autonomic system and reduce pain.
A neurologist's approach to pain is based on a thorough knowledge of
how the body works and how the brain contributes to suffering from pain;
not just how medications or injections can mask the pain. Our goal is
to help our patients manage pain so that they can continue to live their
everyday lives, or in this case get back to sports careers they love.
In cases of post-surgical pain this can simply be a matter of time for
the surgical site to heal, or it can mean nerve or other damage that requires
Tragic stories of opioid abuse and overdose among talented athletes have
captured the headlines on sports magazine covers and websites as well
as impactful television docuseries for years. These are people who devoted
a career to a sport – only to be robbed of it by injury, surgery,
and then by addictive drugs that were supposed to help them get back to
a game or life they loved. In other cases, after retirement from sport,
individuals suffer from uncontrolled or poorly treated painful conditions
that expose them to opioids, depression, and risk of addiction. Now that
we as a medical community know better, we can do better for athletes and
every patient who needs to get back into the game and/or workplace after
injury and surgery. Once a decision for surgery has been made, management
of the pain associated with the intervention matters. We know opioid addiction
continues to be a significant problem in our country, and even the most
elite athletes aren't immune to it. Health care providers, coaches,
and athletic trainers must work together to support our athletes'
recovery after surgery. Whether we are an athlete, construction worker,
or first responder, we all deserve the opportunity to pursue our best
lives without the albatrosses of constant pain and addiction.