An orthopedic physician (MD or DO) specializes in the diagnosis, treatment, and prevention of conditions affecting the musculoskeletal system. This system includes the bones, joints, ligaments, tendons, muscles, and nerves throughout the body. Orthopedic issues, ranging from acute injuries like fractures to chronic conditions such as arthritis, are inherently linked to pain and mobility problems. While orthopedists are known for performing surgery, they also use a wide array of non-surgical therapies to restore function and alleviate discomfort.
Scope of Prescribing Authority
Orthopedic surgeons and physicians possess the full legal authority to prescribe any necessary medication, including controlled substances like opioids. As fully licensed medical doctors, their prescribing privileges are identical to those of any other physician. This authority extends to managing pain resulting from injury, chronic conditions, or surgery.
The context of the pain heavily influences prescribing decisions, particularly for controlled medications. Orthopedists frequently use their prescribing power in acute settings, such as immediately following surgery or a severe fracture. In these cases, a short course of stronger pain relief is often appropriate.
Management of chronic, long-term pain is approached with greater caution. Many orthopedic practices adhere to guidelines favoring short-term opioid use, typically limiting initial acute prescriptions to seven days or less. They often consult state-run Prescription Drug Monitoring Programs (PMPs) before issuing a controlled substance to ensure patient safety and prevent misuse. This reflects a wider medical shift toward non-opioid strategies for persistent musculoskeletal discomfort.
Categories of Pain Medications Prescribed
Orthopedic physicians employ a multimodal approach to pharmacological pain management, drawing from several distinct categories of medications. The most common first-line agents are Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen and naproxen. These work by inhibiting enzymes that produce pain and inflammation, effectively reducing swelling and moderate pain related to conditions like tendonitis or acute sprains.
When muscle spasms accompany an orthopedic condition, such as a herniated disc, a muscle relaxant may be prescribed. Medications like cyclobenzaprine or carisoprodol depress the central nervous system to relax spastic muscles, typically used short-term. For pain caused by nerve compression, the orthopedist may prescribe nerve pain medications, such as gabapentin or pregabalin. These agents stabilize overactive nerve signals that cause shooting or burning pain.
Opioid analgesics, including hydrocodone and oxycodone, are typically reserved for moderate to severe acute pain. They bind to opioid receptors in the brain and spinal cord to block pain signaling. Due to the risk of dependence and misuse, their use is minimized, primarily limited to the immediate post-operative period or severe acute injuries. Current practice dictates prescribing the lowest effective dose for the shortest duration, often combined with non-opioid medications for enhanced control.
Non-Drug Pain Management Strategies
Orthopedic care often prioritizes conservative and non-pharmacological methods, integrating them with or preceding medication use.
Physical therapy is a fundamental element, involving targeted exercises and manual techniques to restore strength, flexibility, and range of motion to an injured area. A physical therapist develops a personalized plan to improve function and reduce reliance on pain medication.
Immobilization is another common strategy, utilizing braces, splints, or casts to support and protect injured tissues, allowing them time to heal without further stress. Targeted injections also provide localized relief without systemic medication effects. Corticosteroid injections deliver potent anti-inflammatory medicine directly into a joint or soft tissue space, such as a bursa or tendon sheath.
Viscosupplementation, involving hyaluronic acid, is often used to treat osteoarthritis, particularly in the knee. This gel-like substance is injected into the joint to improve lubrication and shock absorption. Patients are also advised on the RICE principles—Rest, Ice, Compression, and Elevation—to manage acute swelling and pain at home.