Tommy John surgery is an effective medical procedure that allows baseball pitchers with elbow injuries to return to peak performance. Tommy John surgery, named for the first pitcher who underwent the procedure, involves relocating a tendon harvested from one place in the person’s body, to replace the damaged elbow ligament. However, Medial Ulnar Collateral Ligament (UCL) Reconstruction, as it’s formally known, is far from trivial. Holes are drilled into the bone and the new ligament is threaded through. Even though the surgery can be done as a day procedure, ongoing pain can result.

This kind of damage to a ligament is the result of micro-injuries that accumulate over time. They’re common in baseball pitchers, who have to generate powerful momentum during overhand pitches. Blowing out the UCL results. Typically, it’s simply the result of way too much overuse of the UCL. Especially for young players, even Little Leaguers, is the need to take it easy from time to time, during the off-season. Ballplayers just aren’t known for throttling back, and so that ulnar collateral ligament finally ruptures. It’s a painful injury that was once slow-healing and career-ending. Since the advent of Tommy John surgery in 1974, damage to the UCL has been correctable.

Tommy John surgery leads to considerable post-operative pain, often severe, that lingers. Chronic pain results in athletes receiving opiate-class pain relievers.  Athletes want to get back in shape, back to practice, and painkillers do provide a cushion, but at the same time, using them regularly can, and does lead to addiction. It’s that combination of high-intensity focus and competition, combined with the potential pitfalls of opiate addiction, that lends high risk to the aftermath of sports-trauma surgery.

Opiate and opioid painkillers are the most commonly given drugs for moderate to severe pain. Even though they’re the best at moderating severe pain, they’re very poor choices for chronic pain, given that they lose their effectiveness over a short period, causing the sufferer to take increasing amounts of the opiates. That’s a rapid path to addiction, and addiction amongst athletes is common.

Opiates are effective for moderate to severe pain. They’re great for post-operative pain. However, chronic pain and opiates don’t mix.  The longer a person takes opiates, they less those opiates reduce pain, due to the body’s increased tolerance. Then, a person’s body comes to rely on the opiate for all pain control (a process known as habituation.) At that point, the athlete’s body stops making its own powerful painkillers, the endorphins, and has no defense against pain of any sort.

This is a staggering problem, given that Tommy John surgery’s prevalence has been skyrocketing since 2012. Many pitchers look for it as a means to stay competitive, even though they haven’t blown their UCL. In fact, younger and younger players are having Tommy John surgery in an attempt to gain an advantage over the competition. Given this uptick in surgeries, it’s logical to presume more ballplayers are suffering from addiction. Unfortunately, that’s the case.

Elbow injuries due to pitching are chronic, which leads to both over prescription and overuse of opiate pain medications. The most common pain medications for damaged joints, tendons, and muscles, all found in the opiate class, lose their ability to adequately control pain during chronic use. To get the same pain reduction, a sufferer must increase their dosage. Sometimes they use more, much more than recommended. Bumping up the amount taken yields meager results, but the addictive effects of the drug go up over lengthy use, regardless of the efficacy of pain relief.

Opioid addiction treatment takes place in a number of settings. Most opiate addicts require medical detoxification. Opioids leave the system. It’s very rough on the body when there’s no more artificial cushioning from pain, and as discussed above, long term opioid use robs the brain of its ability to produce natural painkillers, in the form of dopamine and the endorphins.

Dopamine is the brain’s pleasure and pain modulating chemical. Once a chemical from outside the body forces dopamine producing tissues to overwork, a point comes where those areas of the brain stop making any natural painkillers. They also stop releasing and “pleasure positive” chemicals at all. People often turn to opioids in even greater dosages, just to feel any kind of happiness. This is, of course, a brutal cycle that leaves a person miserable, thoroughly addicted, and unable to function. Fortunately, there’s treatment for opiate and opioid addiction.

Opiate addiction treatment usually involves a period of medical observation, in which the individual is treated within a medical facility or rehab hospital with around-the-clock physician and nursing staff. Coming off of opiates can be very painful, even dangerous. Medications can be administered that reduce the pain and smooth out the transition period while the body detoxes. During that time, it’s crucial that the recovering person not take in any more opiates. Inpatient observation can make sure that doesn’t happen.

Even after a person gets past initial detox, the brain takes a while for dopamine and the other pleasure/pain control chemicals to come back to normal levels. During that period is when most people relapse It’s the craving for the drug, which is lightyears beyond a mere desire, that causes the relapse. A drug craving is an overwhelming, life-or-death urge to use the addictive substance.

However, there are effective treatments for opioid addiction and the cravings that lead to relapse. A medication called suboxone can alleviate these craving and make them well within a tolerable range. Suboxone for opiate addiction relieves the craving for the opiate, allowing the recovering addict a measure of peace from the torment of always needing to use. Physicians that prescribe suboxone usually do so within the framework of a opiate addiction rehab. Typically, once detox is over, a person will be discharged home and able to carry on with their lives, as long as they maintain regular contact with a recovery group or a recovery professional. In the case of players taking suboxone to ameliorate cravings, that’s usually a sports physician or addiction specialist.

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