Pain Relief and the Opioid Crisis in the United States and Canada.

Opioid analgesics hijack the body's innate wellness machinery (eg, naloxone blocks the placebo effect) and alleviate both physical and emotional pain. Starting in the 1980s, marketing and advocacy created an opioid-centric pain relief strategy based on the idea that physicians undermanage pain and worry too much about addiction. The increase of prescription opioids in the ecosystem (along with a resurgence in heroin use) contributed to dependence, misuse, overdoses, and overdose deaths. Laws punishing undermanagement of pain from the opioid crisis combined with more recent laws punishing overprescription of opioids add to the difficulties orthopaedic surgeons have in managing the pain of surgery and acute injury. The substantial variation in pain intensity for nociception (actual or potential tissue damage) and the persistent use of opioids after healing is well established are both accounted for largely by psychosocial factors (stress, distress, and less effective coping strategies). When a patient has more pain than expected, surgeons should first rule out compartment syndrome and infection and then focus on a comprehensive team- and strategy-based approach that addresses these psychosocial factors.