A Physician’s Perspective: Considerations for prescribing opioids and acetaminophen for pain patients

An Interview with Brian Hatten, M.D.

Healthcare providers are the main source of information for patients when it comes to which medicines to take, both over the counter and prescription. There are many things to consider when treating chronic pain patients, from how to talk to patients about their medications, to determining if prescription medications are necessary, and the risks associated with combining certain medications such as acetaminophen and opioids.

Recently, Brian Hatten, MD, Orthopaedic Surgeon at the Orthopaedic Clinic of Daytona Beach sat down with PainEDU to share his insights on managing the medication process for patients with chronic pain. Read the complete interview with Dr. Hatten below.

Dr. Brian Hatten is a board certified orthopaedic surgeon who specializes in total joint replacements, arthroscopic management of athletic injuries, and complex fracture management. A native of Long Island, New York, Dr. Hatten earned his B.S. from Cornell University and his M.D. from New York University, where he was a member of the Alpha Omega Alpha Medical Honor Society. Dr. Hatten has practiced general orthopaedics at the Orthopaedic Clinic of Daytona Beach since joining in 2004. He uses the newest technological advancements to treat a wide variety of bone, joint, ligament, and tendon disorders, and improving patient outcomes is among his top priorities. After recognizing the gap in reliable patient information around knee surgeries, Dr. Hatten created My Knee Guide. This free iPhone app serves as an interactive and comprehensive resource for patients considering and undergoing knee replacement surgery.Dr. Hatten is also a Fellow of the American Academy of Orthopaedic Surgeons and is involved in a variety of medical activities within the local community. In the past, he has served as the Chief of Orthopaedic Surgery at Halifax Medical Center and on the Executive Committee of the Volusia County Medical Society.

Jeannette Pforr, Marketing Manager:

In dealing with patients with chronic pain, at what point do you prescribe opioid medication and what steps do you take to ensure the safe use of these drugs?

Brian Hatten, M.D.: OTC pain relievers like acetaminophen and NSAIDs are generally safe and effective when used as directed, especially if the pain is mild to moderate. However, as chronic pain conditions such as knee arthritis progress, the use of OTCs may have less beneficial effects and the symptoms of pain can become more difficult to manage. As an orthopaedic surgeon, I do not provide or recommend the chronic use of narcotics (opioids) for arthritic conditions. However, I am aware that other physicians will use narcotics to treat these types of conditions. Patients who do take chronic narcotic medicines must be aware that certain brands may contain acetaminophen in addition to the opioid. With any medicine that contains acetaminophen, the steps to ensure safe use are: always read and follow the label, know if your medicines contain acetaminophen, take only one medicine at a time that contains acetaminophen, and ask your healthcare provider or a pharmacist if you have questions about dosing instructions or medicines that contain acetaminophen.

 

JP: Why is reading and following directions on medicine labels so particularly important with respect to acetaminophen-containing analgesic products?

BH: Reading and following the label will always help you avoid taking more than one medicine with acetaminophen at the same time. Taking more acetaminophen than directed is an overdose and can lead to liver damage. Also, medicines containing acetaminophen come in a variety of strengths, and if you don’t read and follow all labels, you may exceed the recommended daily limit. The FDA recommends taking no more than 4,000 milligrams of acetaminophen in a 24-hour period.
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JP: What concerns do you have, if any, about prescribing opioid pain medications that contain acetaminophen?

BH: Narcotics are sometimes used to help treat the symptoms of conditions like knee arthritis, but when used as a treatment for chronic arthritis, narcotics become addictive. The body builds up a tolerance to this type of medicine and requires higher doses to obtain an effect, which could result in an overdose of acetaminophen. Long term use of acetaminophen-containing narcotics should be avoided. Again, I don’t recommend chronic use of narcotics for arthritic conditions, but other physicians may.

 

JP: What are the dangers of taking over-the-counter medications containing acetaminophen for patients who have been prescribed an acetaminophen-containing opioid medication for pain?

BH: If patients are using OTC and prescription pain relievers, it’s important to know if more than one of the medicines contains acetaminophen, because again, you could accidentally exceed the recommended daily limit and risk liver damage. Talk to a healthcare professional before taking an OTC medicine with acetaminophen if you’ve already been prescribed an opioid with acetaminophen.

 

JP: What would you say are the most important steps that healthcare professionals can take to help chronic pain patients use acetaminophen safely and effectively?

BH: Always ask your patients not just what other prescribed medicines they’re taking, but also what OTCs they take, be it regularly or just occasionally. Urge patients to read and follow drug facts labels every single time they take an OTC medicine. Remind patients to avoid the three most common acetaminophen dosing mistakes: taking the next dose too soon, using multiple products containing acetaminophen, and taking too much at one time.

 

JP: Can you tell us a little about the Know Your Dose Campaign and the My Knee Guide that you developed?

BH: When talking with patients, a helpful resource is the Know Your Dose campaign, which educates consumers on how to safely use medicines that contain acetaminophen and provides free educational materials to healthcare providers. Know Your Dose is sponsored by the Acetaminophen Awareness Coalition (AAC), a group of leading health, healthcare provider, and consumer organizations advised by American Academy of Pediatrics, Centers for Disease Control and Prevention, and U.S. Food and Drug Administration.
Healthcare professionals can also recommend My Knee Guide, an interactive and comprehensive resource I created for patients considering and undergoing knee replacement surgery. My Knee Guide provides users an unprecedented ability to customize their experience of knee replacement surgery, with a learning center providing educational tools and references for both non-operative and operative treatment options.