The OIPMC provides care for total joint reconstruction, shoulder & knee, hand and wrist, sports medicine/arthroscopy, back and neck, foot and ankle and general orthopaedics.
The centre claims to deliver “exceptional care” as part of its “premier rehabilitation specialist” service – a service that is “unsurpassed” and result in patients “consistently providing us with the highest marks in patient satisfaction and overall medical experience.”
They provide “the highest quality care to every patient”, “through an understanding of each individual patient's problem and applying the latest in medical advances and technology toward obtaining the goal of full recovery”.
“We consider our patients as members of our extended family.”
Well, unless you happen to be a member of the OIPMC family who happens to have quit smoking by using NRT products or vaping, because then they don’t want to know you.
A letter sent from the centre’s Doctor John T Ruxer informed current patients: “We at the Orthopaedic Institute Pain Management Centre of Western Kentucky have a no-nicotine policy. If you are currently a smoker or using any nicotine products (chewing tobacco, nicotine gum, and nicotine patches, etc..) and we are treating you with opioid medication, you will be given 6 months to be completely nicotine free or we will no longer prescribe your opioid medication. This policy is based on our stance that the use of nicotine products greatly affects you overall pain status. In addition, nicotine disrupts your pain cycle and limits the effectiveness of medication.”
Patients have been given the option to sign and return the letter immediately or promise to quit all nicotine products within 6 months.
While it may seem reasonable to ask patients to quit using nicotine products if they inhibit a successful treatment and recovery, the claims made by Ruxer lie at odds with other research.
In 2014, Doctor Pamela Flood, Department of Pharmacology at Virginia Commonwealth University, wrote an article titled “Nicotine Is Out - Nicotinic Agonists May Have Utility as Analgesics” for the Anethesia & Analgesia journal.
In her piece, Flood detailed a meta-analysis by Mishriky and Habib, including 9 double-blind randomised trials, that evaluated the analgesic efficacy of nicotine for acute postoperative pain. The authors concluded that administering nicotine at or around the time of an operation was linked to “a statistically significant reduction” in opioid use afterwards – “and a statistically insignificant reduction in pain scores 24 hours after surgery”.
Denying pain medication to recovering patients because they’ve managed to stop smoking seems to be more than a little unfair, at there appears to be many alternatives in Western Kentucky [link].