This is a great question, and a very important topic given the opioid crisis this nation finds itself in the middle of.
Dr. Feldman will electronically submit all of your prescriptions, including pain medication that you will take only for the first few days after surgery, at your pre-op appointment. We will not refill or provide any additional narcotic pain medication. Dr. Feldman performs 400-500 augmentations per year, so we know how many pills are required to make you comfortable early in your healing. If you have discomfort after that, you’re doing too much and Tylenol will help. Amazingly, the dog never eats the antibiotics, the anti-inflammatory pills never fall in the toilet, and the pharmacy never forgets to fill the nausea pill. It’s not our first rodeo.
All narcotic pain medication, including Hydrocodone (Norco) and Tramadol, have abuse potential. How one compares to the other is a tough thing to measure. Remember the manufacturers of OxyContin came to market advertising how safe their formulation was, claiming it lacked any abuse potential, and we've seen how that has turned out, a complete and utter lie. Tramadol differs from other opioid pain medications as it also works on other pathways similar to antidepressants, which likely explains why some patients get more benefit (and abuse potential) from it than others.
So what are your options if you want to minimize opioid pain medication due to fear of addiction or avoid it altogether due to prior abuse.
Celebrex (Celecoxib), a “Super Motrin” that does not thin your blood, has been fantastic at reducing the duration and amount of pain pill use since it went generic. It's now $20-40 (check pricing on goodrx.com) rather than $400 and Dr. Feldman prescribes it to all Breast Augmentation patients.
Dr. Feldman may offer double strength Celebrex and extra strength Tylenol as the safest, completely opioid free, option. You may experience breakthrough pain for a few days and everyone's pain threshold varies as to how tolerable this would be. However, even a small number of pain pills could put a prior dependent into a tail spin so Dr. Feldman would have to weigh the risk versus benefit, but could also be a reasonable option for 24-48 hours in combination with Celebrex and Tylenol in the case of breakthrough pain.
Ultimately, Dr. Feldman believes the subjective pain score, and ease of filing complaints against physicians who use objective vital sign data to refuse prescribing pain meds to drug seekers, to be the root cause of the opioid epidemic. Obviously there are a few shady physicians running pill mills, but the majority of pain meds are not coming from that environment. The subjective pain score should be eliminated from medicine immediately. Treating pain should be based on objective data. A smiling, laughing patient with normal HR and BP (presuming they're not on a beta blocker) cannot have 10/10 pain. After surgery, it is unrealistic to expect to be pain free, but Dr. Feldman believes many outlets have led patients to believe pain medication will magically make them completely pain free.
Lastly it would be worthwhile to be tested for HIV and Hepatitis, prior to surgery, with any history of IV drugs, particularly given new treatments that are able to cure Hepatitis C and suppression of HIV to undetectable viral loads.