On Episode 4 of the Between the Bones Podcast, host Adam Walker sits down with OrthoCarolina shoulder and elbow surgeon Dr. Nady Hamid to talk about his work with the Carolinas Opioid Reduction Effort, or CORE, through OrthoCarolina’s Research Institute (OCRI).
Adam and Dr. Hamid discuss the origin story of the CORE project, the state of the opioid crisis in the US, the research goals of the project, and what role orthopedic providers play in navigating the opioid epidemic.
AN ADAMANT PATIENT SPARKS A CREATIVE INITIATIVE
Dr. Hamid shared that his former patient inspired the Carolina Opioid Reduction Effort (CORE) project. This patient had undergone shoulder replacement surgery previously with the surgeons at OrthoCarolina. When he met with Dr. Hamid to discuss a treatment plan for his second shoulder replacement a few years later, he was adamant about not using any opioids during his post-operative recovery period.
After his first shoulder replacement surgery, during which he was prescribed opioids for pain relief, this patient became addicted to the opioids. He then sought out opioids from other doctors and eventually bought the drugs on his own accord outside of a medical office. This addiction led to personal problems in the patient’s life. He lost his job and went through a divorce. Now in a healthier place but in need of another shoulder replacement, the patient was resolute in his request to not use opioids during the recovery period.
This determined patient sparked curiosity in Dr. Hamid and his team at OrthoCarolina. Eventually, the care team set up a specialized treatment plan.
Dr. Hamid shares on the podcast: “We worked with the anesthesia team and the pain management specialist and used a lot of different alternative medications, and we did zero opioids, and he did great. He was super appreciative that he didn't have to run the risk of having to go on those medications again.”
THE CAROLINA OPIOID REDUCTION EFFORT (CORE) PROJECT BEGINS
This patient success story sparked the idea of the CORE project and got Dr. Nady Hamid thinking: “How many more patients we could do orthopedic surgery on that don't need any opioids at all? And could they potentially even do better without opioids?”
The OrthoCarolina team set up a pilot study with around 50 patients. The non-opioid medical treatment worked for many shoulder replacement surgery patients. The team was committed to the pursuit of finding alternatives to opioid medications, where patients could recover comfortably and safely from their procedures without having to deal with the many risks that can come from using opioid medications.
Though the pilot study only involved patients undergoing shoulder replacement surgery, Dr. Hamid predicts that the program's success can extend to other types of surgery, including the foot, the hand, or the spine.
WHAT ARE THE RESEARCH GOALS OF THE CORE PROJECT?
The Carolina Opioid Reduction Effort project is the nation’s first comprehensive study designed to assess the effectiveness of opioid-free pain management for patients. The goal of the CORE project is to create awareness and physician-supervised action in determining safe and effective alternatives to opioids.
The physicians working on the project are not using any experimental medications in their studies, but instead are utilizing existing medicines with new methods of combination or delivery. Funded by a multi-year research grant from The Duke Endowment, doctors leading the CORE project plan to work with patients recovering from a variety of orthopedic surgeries. With a diversity of patients, surgery types, and medical history, the project hopes to yield results that are potentially far-reaching in their application.
WHAT ROLE DO ORTHOPEDIC PROVIDERS PLAY IN NAVIGATING THIS EPIDEMIC?
Dr. Hamid states that orthopedic providers have an essential role to play in the opioid epidemic because “orthopedic surgeons are one of the biggest prescribers of opioid medications because we do a lot of surgeries. We do a lot of big surgery, and we feel like we need to provide medications to keep our patients comfortable.” Because orthopedic surgeons are some of the leading prescribers of these pain relievers, they have a responsibility to explore alternative and safer methods of pain reduction for their patients.
Additionally, orthopedic providers must work to dispel the myths and stigmas around alternatives to opioids. Hamid speaks candidly on the podcast with a common refrain that family members and even other doctors and nurses repeat when non-opioid medications are suggested, “What? Are you going to do Aunt Betty’s shoulder replacement with no painkillers? Why are you trying to make her suffer like that?” Conventional wisdom regarding pain management, that opioids are the best choice for decreasing pain, is still prevalent in our country despite the well-understood potentially addictive side effects of using these opioids.
However, with the focused effort of the CORE project, surgeons at OrthoCarolina’s Research Institute are discovering the efficacy of alternative medications and therapies that provide the same level of comfort and stability to their recovering patients post-surgery. With more research and studies conducted through the project, alternative therapies will create a compelling and research-driven counter option to opioids.
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This information is provided as an educational service and is not intended to serve as medical advice. If you are seeking specific orthopedic advice or assistance, please consult with your OrthoCarolina physician or locate one in your area through OrthoCarolina’s website at www.OrthoCarolina.com.