Returning to Physical Activity

Patients in the Perioperative Pain Clinic take opioids only when necessary.

Anesthesiologist and pain management expert Marie Hanna has two rules for the patients in the Perioperative Pain Clinic she directs. They must not get any opioids, legal or illegal, from anyone outside her clinic. And they can take opioids only when necessary — not to eliminate pain, but to provide enough relief to allow physical activity. 

Hanna recently reviewed those rules with Johnathan, an 18-year-old Pennsylvania man recovering from a grueling surgery at The Johns Hopkins Hospital to remove his pancreas, gallbladder, spleen, duodenum and 5 percent of his stomach.    

Severe, chronic pancreatitis has been the defining fact of Johnathan’s life since he was diagnosed at 13. He stopped playing soccer and basketball and switched from public school to homeschooling. He rarely left home, except to go to his local emergency department several times a month when the pain spiked.

Doctors there gave him oxycodone and morphine for the pain, says his mom, Brynn. But then they stopped prescribing the opioids and gave him Tylenol instead — an increasingly common response to broad concerns about opioid overuse.

In Johnathan’s case, however, taking away the pain medication left him “in agony,” says his mom. “The doctors said he was an addict,” she says. “He wasn’t. He was a kid with pancreatitis.”

Three weeks after his surgery, Johnathan and his parents are in Hanna’s clinic, seeking a way forward that allows him to take the medications he needs, while giving him a plan to wean off them and return to physical activity.

“When patients like this come to us, we have to give them everything we can to treat the pain,” Hanna assures the family. She cuts Johnathan’s opioid prescription down to two tramadol per day, urging him to take the opioid only when necessary.

“We’re not going to take the pill to kill the pain,” she instructs Johnathan. “We’re going to take the pain pill to get active.” She urges him to start with simple activities, such as going to the local mall.

As the family schedules Johnathan’s next appointment, Brynn is relieved. “After being told for three years that nobody can do anything for his pain, it’s nice to have someone who is confident she can help,” she says.

Three months later, Brynn reports that Johnathan is taking no medication at all and his pain has “drastically decreased.” He’s more active, and though the pain has not disappeared, “he no longer requires narcotics to control it,” she says.