The ERAS program at Aiken Regional Medical Centers seeks to reduce the amount of opioids and narcotics prescribed to patients after surgery.

For many people who suffer from opioid addiction, their first exposure to highly addictive pain medication was in a hospital.

"There's no such thing as painless surgery," said CRNA Jeff Boswell of Aiken Regional Medical Centers. "For many years the only way to do that (manage pain) was with high-powered drugs called narcotics or opioids. You don't have to look much in the news to see we have quite the opioid crisis in America."

Boswell, an anesthesiologist, is familiar with the process of pain management for patients who require surgery. He is part of a growing number of physicians who believe opioids, in addition to having "tremendous" amounts of negative side effects, may not be the best way to treat pain for all patients.

Boswell is one of the medical professionals at Aiken Regional who works with a program called ERAS (enhanced recovery after surgery) that was implemented around three years ago. ERAS marks a philosophical shift in medicine that began in Europe and initially spread to the U.S. through academia-based medical centers.

"Essentially, what it does is it forces all of us who have some component of care over the patient to take a step back and re-examine everything that we do," Boswell said. "For many years in healthcare we did what we did because it has always been done."

ERAS works from an evidence-based standpoint that requires doctors to examine results, not tradition, to determine what produces the best outcome for patients.

It's also part of a growing movement to limit the amount of prescription opioids being given to patients who are recovering from surgery.

"It has to do with a shorter stay in the hospital and a quicker return to normal function," Boswell said. "A lot of times that deals with the management of pain."

Boswell said pain is a "complicated phenomenon" that is largely subjective. An injury that causes severe pain to one person may be felt less intensely by another person with the same injury.  

He claims that is also the reason why the "scale of 1 to 10" rating of pain isn't always very accurate or informative of a patient's condition.

ERAS doesn't mean using less pain medication – it means using medication or a combination of medications that doesn't involve highly addictive opioids or narcotics.

Dr. Lorenzo Sampson, a general surgeon at the hospital, was instrumental in bringing some of those drugs to Aiken Regional.

"The ERAS protocol enables the use of less narcotic pain medication, early ambulation and early diet after bowel surgery," said Sampson.

Sampson said some of the drugs used in place of opioids are the Entereg drug, Celebrex, Robaxin, Gabapentin and Toradol. 

"Overall, the ERAS patient requires little to no narcotics postoperatively," Sampson said. "By using fewer narcotics, Aiken Regional Medical Centers is helping to combat the prescription drug abuse problem that has become a crisis in the city, state and country."

Boswell said limiting the use of opioids doesn't just lower the chances of post-surgery addiction developing but also gives patients a shorter hospital stay, as the side effects of opioids "tend to keep people in the hospital longer."

"If we can reduce their tendency to become one of these statistics, we'd like to do that," Boswell said.

Boswell claims the ERAS program has made a "tremendous difference" since it was implemented. In some cases they have seen opioid prescriptions cut by 90% and hospital stays halved.

He said the best advice he can give patients looking to possibly reduce their opioid use after surgery is to have an early conversation with their doctors and to always ask "open ended questions" about what a doctor recommends regarding opioid reduction programs.

Kristina Rackley is a general assignment reporter with the Aiken Standard.