Opioid
Prescription pain relievers like hydrocodone and oxycodone — powerful but short-acting, used for acute post-operative pain, and important to store safely.
What they are
Opioids are a class of medications that bind to receptors throughout the nervous system to change how pain is perceived. They include prescription medications like hydrocodone (Vicodin, Norco), oxycodone (OxyContin, Percocet), codeine, and tramadol (Ultram, ConZip). They are derived from opium poppy or are synthetic versions of the same mechanism.
In orthopedics, opioids are used short-term after surgery when acetaminophen and NSAIDs alone don’t provide enough pain control. They are not a first-line treatment for chronic joint or tendon pain, and modern practice strongly discourages long-term opioid use.
Acute post-operative use
After surgery, pain is real and needs addressing. Opioids are part of the toolkit. A post-operative prescription for 5–10 days of oxycodone or hydrocodone after a rotator cuff repair or knee arthroscopy is appropriate, and it works. The goal is to provide pain relief during the acute healing window, combined with physical therapy, rest, and gradual motion.
The approach has shifted: we aim for the lowest dose, shortest duration, and fastest taper off the opioid. This is called “multimodal analgesia.” Combining an opioid with acetaminophen and an NSAID (if tolerated) allows lower opioid doses and earlier discontinuation than opioid monotherapy.
Why “less is more” now
Opioids are habit-forming. Some patients are physiologically more vulnerable to dependence than others. Risk factors include personal or family history of substance use disorder, younger age, pain catastrophizing, and psychological distress. Even patients without these risk factors can develop physical dependence if opioids are used for weeks on end.
The opioid epidemic of the 2000s and 2010s taught the medical system that indiscriminate opioid prescribing leads to addiction. Modern orthopedic practice is deliberately conservative: we keep post-operative prescriptions small, time-limited, and paired with non-opioid pain management. Chronic non-cancer pain (arthritis, tendinopathy) is treated with non-opioid approaches whenever possible.
Non-addictive alternatives
For many orthopedic problems, we can avoid opioids entirely:
- Acetaminophen and NSAIDs — the foundation of post-operative pain control, especially when combined.
- Corticosteroid injections — for inflamed joints and bursae, providing rapid relief without opioids.
- Platelet-rich plasma (PRP) — for tendinopathy and early arthritis, addressing the problem rather than masking pain.
- Physical therapy and activity modification — the foundation of long-term pain management.
- Bracing and support — reduces stress on the injured area during healing.
Storage and disposal
If you receive an opioid prescription after surgery, take only what you need for acute pain. Unused pills should not stay in your medicine cabinet indefinitely. They pose a risk: accidental ingestion by a child, unintended use by another family member, or diversion to someone else.
Many police departments and pharmacies operate secure disposal programs. The DEA hosts a Controlled Substance Take Back program. If no program is available, the FDA recommends placing unused opioids in a sealed bag with unappetizing materials (coffee grounds or cat litter), sealing the bag in a container, and disposing in household trash. Never flush opioids unless the label specifically says to.