AAOA welcomes guest bloggers to share their perspectives on how to prevent the misuse and abuse of prescription opioids. This is the third post in our “Spotlight Series” in collaboration with AAOA partner PA Foundation on how PAs across the country are working to raise awareness about the rights, risks and responsibilities associated with prescription opioids. This post is written by James Delaney, MS, PA-C, CAQ-OS, Vice President of the PA Foundation Board of Trustees, and a PA at Direct Orthopedic Care (DOC) in Plano, Texas.
Every year, approximately 8 million students participate in high school athletics. With students across the country back to class — either virtually or in person — many families are also resuming participation in after-school athletic programs. Studies show that these activities improve fitness and academics and have long-term leadership benefits, extending far beyond graduation.
While athletics can bring excitement and fun for students, they also bring the risk of injury. According to the CDC, high school athletes account for 2 million injuries, 500,000 doctor visits, and 30,000 hospitalizations annually. Fortunately, many of these injuries are easily treated, and students do not often experience long-term negative effects or complications. However, more serious injuries may call for more significant treatment interventions. At this point, managing pain becomes a priority — and a necessary conversation between the patient, their caregivers and the healthcare provider.
Students can experience many types of injuries, but my work as a physician assistant (PA) focuses on treating patients with orthopedic injuries. Working with adolescents experiencing orthopedic injuries can be challenging, because providers must not only address the anxiety of the student (who is in pain) but also explain the situation to the parent or caregiver. The first step is to always speak to the patient about what happened, and then to explain the injury and pinpoint the pain through a focused orthopedic physical examination and thorough radiology scans.
When treating pain, discussing alternative treatments other than using opioid medications is especially important in orthopedics because the pain can often be addressed without medication. Sometimes the position of the fracture can be adjusted under a local block, a bandage may be too tight, or a cast may not be on correctly. In cases like these, a simple adjustment and proper immobilization of the injury may alleviate the pain. There also are a range of non-opioid treatments available — such as local anesthetics, non-steroid anti-inflammatory medications, or even over-the-counter medications, like ibuprofen and acetaminophen — that can serve as effective pain reducers.
Educating the parent or caregiver on steps that will alleviate pain for the adolescent is critical. I often demonstrate how to roll an ACE bandage or adjust a leg when it is in an uncomfortable position. Walking through these steps helps to ensure that temporary pain or discomfort is quickly addressed to prevent additional injuries or a longer recovery period.
Today, most orthopedic providers have protocols in place to handle post-surgery pain for adolescents and to ensure compliance with prescription opioid restrictions. There are times when it is appropriate to use prescription opioids as part of a treatment plan. In these situations, we tend to prescribe only two days of medication and ask the patient to let us know if there is still pain after that time so we can re-evaluate if an additional prescription is needed or if we can continue treating the injury in another way.
At the point of prescribing, we educate the adolescent on how to take the prescription opioids appropriately and what they might expect in terms of potential side effects. We also cross-check electronic medical records to ensure the patient has not received prescription opioids from another healthcare provider. Research from the Substance Abuse and Mental Health Services Administration (SAMHSA) has shown that prescription drugs are the third most misused substance among adolescents, so we want to do everything we can to prevent the opioids we prescribe from being misused or abused.
Compliance is always a concern with adolescents, and even more so when they are involved in sports. Conflicting advice from trainers and coaches, combined with peer pressure, can sometimes cause student athletes to return to playing before they are fully healed. It is important to emphasize what the athlete needs to do to get better and how long they should rest for the injury to be fully healed. I always explain the healing process to my patients and the steps I’m taking to treat them so they understand my approach and can ask questions along the way.
When patients are looking for resources to better understand their condition and recovery, I highly recommend OrthoInfo from the American Academy of Orthopaedic Surgeons. OrthoInfo is a consumer-facing website with resources to help patients make informed decisions about their health. I also point to AAOA’s consumer resources, especially the patient education video “Managing Pain After Surgery: What You Need to Know.”
Taking steps to alleviate pain and discomfort caused by a sports injury, while discussing alternatives to prescription opioids, can make a significant difference in a student’s treatment, recovery, and long-term health. I encourage others working in an orthopedic setting to always look at the holistic needs of the patient and prescribe opioids only as a last resort for treating pain. Together, we can ensure that America’s student athletes can continue to stay healthy and enjoy the many benefits that come with participating in organized sports.