ROCHESTER, Minn. — A pain management regimen without opioids offered the same pain relief as common prescription opioids, according to two recent studies of common sports surgeries.

Opioids can help people manage pain, but they can be addictive. Nationwide, opioid prescriptions rose from 76 million in 1990 to a peak of 255 million in 2012. Between 1990 and 2017, deaths related to opioids increased sixfold.

The challenge for surgeons is to minimize opioid use while optimizing patients' pain control after surgery, says Kelechi Okoroha, M.D., a Mayo Clinic orthopedic surgeon and sports medicine specialist. Dr. Okoroha is the senior author of both studies.

Orthopedic and spine conditions account for about 3 in 10 opioid prescriptions, so surgeons can significantly decrease opioid-related deaths by limiting opioid prescriptions, Dr. Okoroha says.

Researchers created an approach to managing pain that eliminated opioids after common sports surgeries. In the first study, participants had undergone knee surgery to reconstruct their ACL. In the second study, participants had undergone surgery to repair their rotator cuff. All received a nerve block before surgery.

In each study, one group of participants received a standard opioid regimen to manage pain. The other group took part in a pain management approach without opioids. The nonopioid regimen included pain relievers, nonsteroid anti-inflammatory drugs and muscle relaxants.

Both studies found that the nonopioid regimen provided at least the same if not more pain control and patient satisfaction, compared with the standard opioid regimen.

In both studies, the most common side effects were drowsiness, dizziness and gastrointestinal symptoms. In the rotator cuff study, participants who received the nonopioid regimen reported slightly lesser side effects than those who received the opioid regimen.

Dr. Okoroha says one way Mayo Clinic is working to limit opioids is offering patients alternatives to traditional pain management.

"I think this is really game-changing research," Dr. Okoroha says. "We've found that it is effective in common sports surgeries. So our plan is to implement it in other surgeries and hopefully decrease the opioid burden worldwide."

Related post: Mayo Clinic Minute: Limiting opioids for postoperative pain management

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The post Expert Alert: Managing pain after knee, shoulder surgeries without opioids appeared first on Mayo Clinic News Network.

As twins, Rachel and Rose Dolmovich do everything together. Nobody thought that would include surgery. Basketball has been their passion since they were 5. But identical injuries nearly crushed their dreams in June 2019.

Watch: Rose and Rachel Dolmovich's Mayo Clinic story.

Journalists: Broadcast-quality video (2:26) is in the downloads at the end of this post. Please courtesy "Mayo Clinic News Network." Read the script.

"I felt like something had moved in my knee. And I collapsed," says Rachel. "It was really, really painful, and I couldn't straighten my knee out."

Moments after jumping to defend a shot during a summer 2019 basketball practice, Rachel says she knew something was wrong as soon as she landed.

Sidelined and awaiting a diagnosis, the Jacksonville, Florida, high school senior was watching her team and her twin sister on the court just days later when Rose endured the same pain and injury.

"It was kind of shocking," says Rose.

The sisters had torn anterior cruciate ligaments (ACL) ― one of the strong bands that stabilizes the knee and connects the thigh bone, or femur, to the shinbone, or tibia.

"I thought that there was honestly a chance that I was never going to play basketball competitively again," says Rose.

They would need surgery, physical therapy and time to recover.

"There are certain people who are at higher risk of getting ACL tears. We know young females are at higher risk. There's some genetics involved with it ― higher-demand sports like basketball, soccer, volleyball," says Dr. Cedric Ortiguera, an orthopedic surgeon at Mayo Clinic.

Dr. Ortiguera, who repaired both Rachel's and Rose's ACLs, estimates more than 150,000 ACL injuries happen in the U.S. every year.

"It was definitely very helpful to have your best friend going through the same thing as you because you're not alone," says Rachel.

Then at their high school's senior night game, with both sisters back in the starting lineup, another setback occurred.

"I was seriously just running in a straight line when I went to turn a little bit," says Rachel. "I just fell to the ground."

This injury meant more surgery, possibly jeopardizing Rachel's future college career.

"It was a much more involved surgery ― what we call a revision surgery, or a second time surgery, but all went well," says Dr. Ortiguera.

Through pain and persistence, the pair grew stronger. The situation even inspired Rose.

"I had a really awesome physical therapist who was huge inspiration for me ― for both of us," says Rose. "It made me kind of fall in love with that career. Ever since then, I've set my goals on becoming a physical therapist and working with young athletes because I want to be able to impact someone."

"With their reconstructed knees, I think they could do almost anything they want, including have basketball careers, but more importantly be healthy and active for the rest of their lives," says Dr. Ortiguera.

Now the sisters find themselves competing together at the same college in Georgia, and their sophomore year could be their best yet.

"Mayo Clinic definitely did their job," says Rachel. "We're super grateful for that, and confident because of how well and how successfully these surgeries were performed."

Her sister echoes these feelings. "I'm on the court, again, with the people I care about ― my team, my best friends. I'm super thankful," says Rose.

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The anterior cruciate ligament (ACL) is one of the key ligaments that help stabilize the knee joint. The ACL connects your thighbone, or femur, to your shinbone, or tibia. It's most commonly torn during sports that involve sudden stops and changes in direction, such as basketball, soccer, tennis and volleyball.

On the Mayo Clinic Q&A podcast, Dr. Matthew Crowe, an orthopedic surgeon at Mayo Clinic in Florida, discusses ACL injury treatment options, including surgery and how proper training can reduce the risk of ACL injury.

Information in this post was accurate at the time of its posting. Due to the fluid nature of the COVID-19 pandemic, scientific understanding, along with guidelines and recommendations, may have changed since the original publication date.  

For more information and all your COVID-19 coverage, go to the Mayo Clinic News Network and mayoclinic.org.

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On the next Mayo Clinic Radio program, Dr. Michael Joyner, an anesthesiologist and human performance expert at Mayo Clinic, will discuss common characteristics shared by elite athletes and what amateurs can do to improve sports performance. Also on the program, Dr. Edward Laskowski, co-director of the Mayo Clinic Sports Medicine Center, will explain knee injuries to the ACL and discuss how proper technique can help prevent ACL tears. And Dr. Jay Smith, vice-chair of Mayo Clinic Physical Medicine and Rehabilitation in Minnesota, will share how regenerative medicine is being used to treat musculoskeletal and spine conditions.

Here's your Mayo Clinic Radio podcast.

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Study co-investigator Michael Stuart, M.D., vice-chair of orthopedic surgery and co-director of the Sports Medicine Center, says, “Many patients, maybe up to one-half, who tear their anterior cruciate ligament are at risk for developing post-traumatic or after-injury arthritis over time. This group of patients affords an opportunity for us to study injured articular cartilage using biomarkers and MRI, then hopefully apply new treatment strategies that can prevent arthritis in the future.”

Journalists: Sound bites with Dr. Stuart are available in the downloads.

Mayo Clinic orthopedic surgeon and sports medicine physician Aaron Krych, M.D., adds, "The hope is that the research on ACL-injured knees will translate to osteoarthritic knees, and that the findings can be used to develop drug therapies and other strategies to prevent or at least delay osteoarthritis."

The project, funded with a $1 million grant from the Arthritis Foundation, also includes the University of California-San Francisco and the Hospital for Special Surgery in New York. The research team includes orthopedic surgeons, radiologists and molecular biologists. The study is expected to take several years.

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