The Anxious Patient Requesting Opioids After Minor Surgery
A 34-year-old woman undergoes hammertoe correction and is 5 days postoperative. She calls reporting pain 8/10 despite acetaminophen and ibuprofen, requests oxycodone, and says she cannot sleep. She has a history of anxiety and prior opioid use after a dental procedure. She denies current substance use. She is tearful and worried the surgery failed. Exam: mild swelling, intact incision, no erythema, no calf tenderness.
1. How do you assess her pain and what non-opioid options should be optimized first?
Read the worked answer
Assess pain quality, location, and function, and screen for red flags (infection, DVT). Optimize multimodal analgesia: scheduled acetaminophen and NSAIDs if not contraindicated, elevation, ice, and activity modification. Address sleep and anxiety, which amplify pain perception. Consider a short course of a non-opioid sleep aid if appropriate. Reassure that mild swelling and pain at 5 days are expected. Document a pain plan and follow-up.
2. If opioids are considered, what prescribing safeguards apply?
Read the worked answer
Check the prescription drug monitoring program, review prior opioid history, and use the lowest effective dose for the shortest duration (e.g., 3-5 days). Discuss risks, storage, and disposal. Avoid combining with benzodiazepines. Schedule a follow-up call or visit. If there is concern for opioid use disorder, refer to behavioral health and consider non-opioid alternatives.
3. How would you respond to her fear that the surgery failed?
Read the worked answer
Explain expected healing at 5 days, show her the incision, and describe signs of normal healing versus complications. Set expectations for the timeline. Offer reassurance and a plan for reassessment. Address anxiety with education and, if needed, behavioral health support. Shared decision-making reduces distress and improves adherence.