Better pain control with fewer opioids

Patients with burns cope with severe pain. Doctors are using a new mix of old medications to reduce the reliance on opioids in the hospital and at home.
March 21st, 2019
A young man on a boat with a big fish.
Naithan Torres loves fishing and cooking gourmet food. Here, he poses with a big catch. Photo courtesy of Naithan Torres.

Naithan Torres loves to cook gourmet food.

One of his showstopper meals is filet mignon topped with a morel mushroom reduction sauce and a side of creamy, herb-infused mashed potatoes.

Torres, 28, was cooking for his younger sister and her friends in Colorado Springs recently when a kitchen accident left him severely burned.

His sister, Sam Torres, 26, was trying to drain a heavy pot full of boiling water and a delicious mix of potatoes from buttery Yukon golds to miniature sweet reds.

Naithan was chopping fresh herbs next to the sink when he saw his kid sister’s grip on the hot pot slipping as she tried to drain the water. Without a moment’s hesitation, Naithan reached in to help.

“I wasn’t going to lose those potatoes,” he said.

But, as he tried to grab the pot, boiling water sloshed over his right arm, from his shoulder to his hand. Torres was wearing a tight athletic shirt that sealed in the heat. As he raced to pull off his shirt, burnt skin came with it.

And so began a terrible journey with pain.

‘The most excruciating, lingering pain I’ve ever felt’

Torres is no stranger to broken bones and other injuries.

“Growing up, I did sports and I was a rowdy kid. I’ve broken a lot of bones. I’ve had stitches. You name it. I’ve done it. I even fell out of a tree and broke my tailbone once,” he said.

“I’ve been hurt a lot and by far, this is the most excruciating, lingering pain I’ve ever felt. I would not wish this upon anybody,” he said.

A young man ended up with severe burns and blisters after a cooking accident. He shows off his burnt arm.
Naithan Torres burned his arm from his shoulder to his hand when he reached in to help his sister while she was draining a pot of boiling potatoes. Photo courtesy of Naithan Torres.

Torres spoke from his hospital bed at the UCHealth University of Colorado Hospital Burn Center on the Anschutz Medical Campus. Many patients suffer from severe pain, but burns are among the worst. In order to recover, patients have to endure daily wound care treatments during which caregivers scrape off the damaged skin, so new skin can form.

Torres had just finished his treatments for the day. Yet, he was able to talk with his doctor and sister and give his 5-year-old son in Texas an update over the phone. That’s thanks to his medical team, which is using new combinations of older medicines and much lower doses of opioids to help patients cope with pain.

Next to Torres’ bed hangs an IV pole with a bag of lidocaine, a non-opioid anesthetic that dates back to the 1940s, but hasn’t been used extensively for burns until recently.

With the opioid epidemic ravaging the U.S., UCHealth doctors from ERs to surgical units to University of Colorado’s renowned Burn Center, are finding alternatives for opioids while keeping patients’ pain in check.

Reducing pain with fewer opioids

headshot of Dr. Patrick Duffy
Dr. Patrick Duffy

“We have gone to an aggressive multi-drug regimen to decrease opioid use,” said Dr. Patrick Duffy, a surgeon and burn specialist at UCHealth University of Colorado Hospital, and an assistant professor at the University of Colorado School of Medicine.

That regimen includes old-fashioned, over-the-counter pain medications. Recent studies have shown that these pain relievers can work just as well as stronger prescription drugs. So doctors in the burn unit give all patients alternating doses of acetaminophen and ibuprofen (unless they have drug allergies). Vitamin C, long thought to help prevent colds, also seems to help with pain.

And, UCHealth’s burn experts have started using lidocaine, a non-opioid medication administered via IVs. They also can use topical lidocaine gel directly on burn survivors’ wounds, along with nerve blocks before treatments.

Headshot of Dr. Anne Wagner
Dr. Anne Wagner

“By blocking the pain receptors before we touch the patients, we need fewer narcotics over the long run” said Dr. Anne Wagner, Burn Center Medical Director and an associate professor at the University of Colorado School of Medicine.

Dr. Arek Wiktor, burn surgeon and Assistant Medical Director of the Burn Center, said the team had to develop a special protocol to use lidocaine for burn patients.

“In the past, only the ICUs were allowed to use it. It’s a heart arrhythmia drug. But, at low doses, it has positive effects on pain. We don’t quite understand how it exactly works,” said Wiktor, an assistant professor at the University of Colorado School of Medicine.

headshot of Dr. Arek Wiktor
Dr. Arek Wiktor

“In terms of getting permission and changing protocols, it was a big change,” Wiktor said. “We’re the only unit in the hospital that’s allowed to do it on floor status patients. We’ve seen no adverse events. We’re collecting data so we can see how best to apply this (throughout the hospital).”

As the burn specialists use opioid alternates, they are tracking and recording the lower doses of opioids that patients need.

An array of non-opioid options, including virtual reality goggles

“We work to taper off opioids very quickly,” Wiktor said.

He said providers in the past gave patients far too many pain pills.

“The U.S. uses 80 percent of the world’s opioids for 5 percent of the population,” Wiktor said.

Now, medical providers must do all they can to reverse the epidemic.

“The whole point is to make sure patients leave us with fewer opioids. We want them to have better pain control with fewer opioids,” Wiktor said. “In the past, patients left with hundreds of pills: oxycodone, MS-contin, methadone, oxy-contin, dilaudid anything you could think of.”

Wagner said the team is still fine-tuning doses and the most effective mix of alternative medications, but the early results are very promising.

“When we use the lidocaine drip, we can decrease the amount of narcotics significantly,” Wagner said.

Doctors and nurses also are tapping patients’ minds to cope with pain. Wagner ordered virtual reality goggles for each room in the burn unit. Patients can distract themselves from pain by traveling to a multi-dimensional world of glaciers, for instance, where they escape to an icy, pain-free landscape.

Providers also set realistic expectations. Burns are painful. And patients shouldn’t expect doctors to eliminate their pain entirely. Therefore, they will wean them off opioids as soon as possible.

“As soon as your wounds are closed, you will not get more narcotics,” Wagner said.

‘Never going back’ to addiction

Torres first sought treatment for his burns in Colorado Springs. Then he came back to his home in Westminster. Torres works in construction and when he saw blisters forming from his hand to his shoulder, he knew he needed more help so he could heal and get back to work.

He visited a hospital in Denver, where experts knew they needed to transfer him to the University of Colorado. It’s the only center for adult burn survivors in the Rocky Mountain region that is certified by the American Burn Association.

For Torres, the efforts to reduce opioid use are especially critical. That’s because he has coped with addiction in the past and never wants to go through it again.

Naithan Torres’ son motivates him to never become addicted to opioids again. Photo courtesy of Naithan Torres.

“I love the idea of this lidocaine. I’m sure the drug addicts hate it because they want opioids. But, it works and it’s a blessing,” he said.

Torres grew up in Texas, south of Fort Worth. Years ago, when he injured his back, he said a doctor gave him prescriptions for pain pills and he got hooked.

“They threw me 100 10 mg. pills of hydrocodone a month. I was 19 or 20. It led me down the wrong path. It took me almost six years to really overcome the addiction,” Torres said.

He said he tried and failed to kick his addiction through multiple stints in rehab programs.

He’d get clean, then would relapse. Finally, he got so sick that he thought he was going to die.

“It was like I had an epiphany one day,” he said.

Torres knew he had to get away from fellow drug users in Texas. His parents had moved to South Carolina. He begged to come stay with them to get a fresh start. It worked and Torres loved spending time fishing with his dad and cooking for his family.

“I finally got past all of that,” Torres said.

He recently moved to Colorado, where his sister and a brother lived. He has stayed clean and gotten good jobs. Torres prays the burn won’t set him back too far. He’s counting on his medical team to help him endure the pain with as few opioids as possible.

“I lost everything,” Torres said. “I made it and I don’t ever want to go back there again.

“I have a little boy. He needs a dad.”