How to Manage Pain While in Recovery

Pain demands attention, but recovery demands protection. We tackle the tightrope walk of treating acute and post-surgical pain without opening the door to relapse, drawing on real experiences from Ryan's orthopedic procedures, brain surgery, and the everyday realities of urgent care. We lay out how the opioid landscape shifted—from misleading claims to prescription crackdowns, heroin spikes, and the current fentanyl crisis—and what that means for anyone navigating pain management today.

We get specific about the strategies that actually change outcomes. Honest disclosure of a substance use history can flip the care plan from autopilot to thoughtful, multimodal pain control. We talk through prescription monitoring programs, urine drug screens, and how stronger systems now help clinicians prescribe more safely. 

At home, accountability matters: let a trusted partner control the bottle, set a hard stop date, secure and dispose of leftovers, and stack non-opioid options like NSAIDs, acetaminophen, ice, and targeted PT. Expect craving memories to flare and plan for them with check-ins, sponsor calls, and simple behavioral tools that lower distress without feeding addiction.

Medication-assisted treatment gets a clear spotlight. If you’re on Vivitrol, Suboxone, or Methadone, your team needs to know before anesthesia or surgical planning. We explain why continuing Suboxone through surgery is evidence-based and safer than stopping, how blockers affect analgesia requirements, and why timing, transparency, and multimodal approaches reduce risk while preserving comfort. 

We also dig into stigma—how it shows up in emergency rooms, why some people withhold key facts, and how empathetic, two-way communication with the right clinician can turn fear into a workable plan.

If you’re facing a procedure, recovering from injury, or supporting someone in sobriety, this conversation offers a practical roadmap for staying safe in the fentanyl era. Subscribe, share this episode with someone who needs a plan, and leave a review with your best tip for advocating for pain care while protecting recovery.

Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Recovery Playbook episodes with Ryan Leaf and Daryl Shorter, M.D.  To submit a topic for discussion, email podcast@menninger.edu. If you are a new or regular listener, please leave us a review on your favorite listening platform!

Visit www.menningerclinic.org to learn more about The Menninger Clinic’s research and leadership role in mental health.

Transcript

Dr. Daryl Shorter: 00:08

Welcome to the Recovery Playbook, brought to you by The Menninger Clinic, one of the nation's leaders in mental health and addictions treatment. I am one of your hosts, Dr. Daryl Shorter.

 Ryan Leaf: 00:17

And I'm the other host, Ryan Leif. And we're here to take you through some more of the exciting conversations around addictions treatment, not only to entertain, but to hopefully educate.

 Dr. Daryl Shorter: 00:28

And today we are going to be talking about managing pain while in recovery.

 Ryan Leaf: 00:34

This is a very touchy subject. Because listen, opioids were made for a reason. They were made for acute pain treatment. Right. Because they work, they do the job they're supposed to. And every interaction I had with any sort of opiate drug was because and after an orthopedic surgery, one that's incredibly invasive, where you are in a lot of physical pain. And the drug worked. It worked for me until the moment came where I was to start rehab and get back to what my first drug of choice, which I like to tell people, was competition. You know, the reason I had to have those surgeries is because of the competition. I was injured. And so that's what got me back to it. But the big question is, and I think you are especially unique in being able to answer this working with people who are currently in recovery or coming to you or seeking recovery, who are dealing with acute or long-term physical pain. How does one navigate that process?

 Dr. Daryl Shorter: 01:44

Yeah. So as a provider, I think we are in a different paradigm from when I was in training 20 years ago. Twenty years ago, we had a lot of pharmaceutical companies coming to us and giving information that was not entirely accurate about the potential addiction liability of being on certain medications. And so I certainly can remember being in training and hearing representatives from certain pharmaceutical companies saying there's no way that you can get addicted to this medication because it only attaches to the pain receptors ---and kind of being like, oh, okay, well, I guess that makes sense. I'm sure there's no possibility that you would go on to develop an addictive disorder just because we are treating your pain appropriately with these medications. And of course, fast forward, we land smack dab in the opioid epidemic, which started off primarily as a prescription opioid epidemic, where people were coming in and, you know, you may have heard that term -- doctor shopping. They were going around trying to…

 Ryan Leaf: 02:51

Well, when I was ultimately charged and… it was called obtaining a controlled substance by fraud is the way, is the legalease of it.

 Dr. Daryl Shorter: 03:07

Okay, well, yeah, we had doctor shopping. Yeah, our way wasn't as nice, I don't think. So doctor shopping was a big part of it, and people were sort of going around and trying to get medications from really anybody, anyway that they could. And as a result, we saw massive numbers of people that were engaging in illicit opioid use as well as experiencing consequences of it, like addiction and overdose. Ss the medical community, and really with the assistance of the government, really began to kind of crack down on opioid prescribing, we saw that the number of prescriptions that were being prescribed and written was going down. And so that's when some of these other things came in. Like first we had a spike of heroin. People typically refer to that as the third wave of the opioid epidemic. And that spike did not last for nearly as long because fentanyl came in, and now we are in what people consider to be the fourth wave of the opioid epidemic or the opioid crisis, the fentanyl crisis. Now, the interesting thing that has happened with fentanyl in the last several years is that fentanyl is also combined with lots of other types of substances, in particular psychostimulants like cocaine and methamphetamine. So, a lot of times when people are coming into treatment today in 2025, if they have been using an opioid, it is oftentimes not heroin, it is fentanyl, and it is oftentimes in combination with a psychostimulant. Okay, so that's the opioid epidemic. So in the middle of all of this, you have people coming in, they have a surgery of some kind, they need a pain medication.

 Dr. Daryl Shorter: 04:32

 What do you do as a prescriber? Well, the first thing is that now, unlike back then when I first started this work, I can check to see if this person has been getting it. If somebody has been prescribed a medication from somewhere else. So we have these prescription monitoring programs where everybody that is prescribing these kinds of medications is really required to be in the prescription monitoring database. And I can look up, and in some cases, in some states, you are required to do so every time you write a controlled prescription. You look them up to see, like, who else is prescribing medications for this person, when's the last time they got that, and you can make decisions in the moment about whether or not you want to prescribe to this individual based on that information. It's huge, it's a huge game changer. The other thing that I can do as a prescriber is I can say, hey, I need a urine drug screen. I need a urine sample today, so we can test to make sure that we can keep you safe so that we're not prescribing medications to you that you really don't need at this moment or that might contribute to some sort of health consequences for you. So I think that the landscape has shifted so that we can provide better care and take better care of people, even though we are in the midst of this crisis that is sort of mutating every a few years, months or two years.

 Ryan Leaf: 05:45

So I, of course, enjoy hearing that immensely because it was directly relative to my process on what I went through. What allowed me to become addicted and feed my habit was the fact that doctors didn't have to talk to one another, not even in their own practices, which was crazy. I would go to the same urgent care and see three different doctors, and all three of them would prescribe me a prescription for opioids. When it was all said and done, and the investigation had gone down into my doctor shopping in West Texas. I had gone to pharmacies over, I think it was, like a three-month span and received over a thousand pills. Wow. And no one had talked to one another.

 Dr. Daryl Shorter: 06:30

No communication, nobody knew anything. There wasn’t like…

 Ryan Leaf: 06:32

It was more protective of HIPAA rights or something like that at the time, I guess. 

 Ryan Leaf: 06:39

It was not in the public self-interest. Yeah. And so that's changed dramatically to the point of my final relapse where I was going through an actual medical crisis where I was in pain. Brain tumor had been removed. There was still residual tumor that was wrapped in my brainstem that I could not get removed, so we had to attack it with radiation. And like anything, when you irradiate anything, one can become sick, especially in the brain. And I was so sick, I was losing my hair, I was in pain, and I just felt like everybody who goes through that experience, I deserve to not feel that pain and everything like that. But if I'd been honest with my radiologist who was doing the radiation, he wouldn't have then seen me in pain and go, oh hey, can we help mitigate some of this pain for you? And when he asked if I would like to be prescribed some opiates, I didn't tell him about my past. And so I think this is probably the best educational part of this all, with anybody who's going through recovery and is dealing with physical pain or going through some sort of post-that process. In the last 13 years since I've gotten out of prison and I've been sober, I've had two surgeries. 

 Ryan Leaf: 08:10

I’ve had a hernia operation. And then I had, I had a lower back thing done from that was an orthopedic one. And in both instances, walking into this discussion with the surgeon, the first thing out of my mouth is I'm a recovering opiate addict. And it happens everywhere I go, no matter if I get brought in for an emergency into an emergency room or to an urgent care center, it's the first words out of my mouth because the different way you will be treated. Like, listen, emergency rooms in this day and age, in this country, in big cities in particular, is triage, right? You are all right, you want to… this guy's in pain, let's shoot him up with some morphine here and move on to the next one when we're going through the process. You walk into a situation like that, you tell the person immediately, their whole treatment plan changes with you. There's almost more of a focus on how to treat you than maybe just the, you know, give them some pain pills and get them moving on, you know, which is maybe what they're there seeking.

 Dr. Daryl Shorter: 09:17

Yeah.

 Dr. Daryl Shorter: 09:17

 I think one of the one of the, I mean, that's a blessing, frankly, that you've had that experience. I think one of the challenges that a lot of people have is that when they walk in and they are either intoxicated at the time that they present to an emergency room or an urgent care, or they are honest about their being in recovery or having a history of a substance use disorder, that the unfortunate stigma that still exists within the medical community,  that comes to the fore instead. And so people are oftentimes, you know, this is what people are trying to wrestle with and bat and then sort of reckon with and balance,  how it is that they might not get the care that they need and deserve because someone is going to withhold hold something from them as well. It's tough. It's a tough thing for people to sort of wrestle with.

 Ryan Leaf: 10:05

And I'm lucky I'm lucky because I just assume when I walk into any room everybody knows my story. That's the very, very narcissistic personality disorder I live in, right? No, no one, no one knows my story. Some people may, but I may have benefited from that narcissistic that narcissism when I walk into a an emergency room or an urgent care that I have to assume this doctor knows that, oh, this is the famous Ryan Leaf who do doctor shopped everywhere. Yeah. When they have no idea who I am. But maybe that part of me allows for me to be more honest about it, you know? And maybe the stigma doesn't exist as much for me because I'm like, oh, the reason why I'm being looked at that way is because I'm, you know, they've already thought I was a piece of shit. And so I think that's benefited me. And your conversation around stigma is the biggest part of this. Like it's the last rail, I think, that that we have to sidestep when it comes to addiction and mental health stigma. I've been using this in my talks a lot lately because I was trying to find the right analogy for for individuals. 

 Ryan Leaf: 11:15

 Two children are diagnosed with a disease on the same block. One is diagnosed with a form of brain cancer. The other is is diagnosed with a form of a mental health diagnosis or substance use diagnosis, how differently those families are treated. That's right. How the family who's diagnosed with cancer, there's a GoFundMe page started, people are bringing over food and messages of support, and everybody's there. The other family may be ostracized, gossiped about, judged, isolated in the dynamic. And if you could understand fully that both of these diseases could be treated in a way that you could go into remission and have the lives of your dream, that would be the way that everybody needs to view this. And this is something that's been learned. You know, you don't come out of the womb and look at somebody who has a mental health disorder or substance use and think of them as bad.

 Dr. Daryl Shorter: 12:13

Yeah.

 Ryan Leaf: 12:14

This has been learned, this has been taught over time, and it's going to take the necessary steps on our parts to remove that stigma. We have to shine a light on it and doing things like this and talking about it. And me, though, through my narcissistic lens of it, may be like, okay, that's the way I'm viewed, not because of the stigma, but rather because of the fact that they know me. No, the stigma is the reason why this exists, and you have to walk through it in a healthy, positive way. So that's kind of what we're at with it. I have done two surgeries, like I talked about, post-recovery in both instances. Transparent with the doctor. My wife, she holds the pain medication, she delivers it to me the way you're supposed to, the way it's prescribed. And then you're done when you're done. Yeah. Like there's no reason to take all the pills. That was always the biggest thing for me, too, right? When I would go into somebody's home and I would find pills in their medicine cabinet, and they were, I don't know, they went and got their wisdom teeth pulled a year ago or something like that, and the doctor prescribed them 30 pills and they've taken two. And I would think, what the hell is wrong with these people?

 Dr. Daryl Shorter: 13:25

Yeah.

 Ryan Leaf: 13:26

Why aren't they all gone? Well, because not everybody's like me.

 Dr. Daryl Shorter: 13:30

And so, in both of those cases, it sounds like you went into it thinking, I'm not going to take all these medications, all these pills that I'm given, and I'm definitely not asking for refills.

 Ryan Leaf: 13:40

Well, and you always walk into that when you're in recovery, but as soon as you take them, you're like, oh, I remember this. I remember. Also, your brain immediately tells you, Oh, I love this. Interesting.

 Dr. Daryl Shorter: 13:47

Okay.

 Ryan Leaf: 13:48

You know, I was texting with people and talking with people at night after my surgery, and some of the nonsense that I was texting, I remembered, oh yeah, I forgot, I forgot what this does to me or how this like if I could have gone through the whole bottle, I would have. But the reason you put it in the hands of somebody responsible who understands, that's the reason why. And my wife after the next day was like, after I got up to go to the bathroom one time and I walked fine without a limp or anything like that, she was kind of like, all right, you're good. Let's go, we'll go to Advil.

Dr. Daryl Shorter: 14:19

Yeah.

Ryan Leaf: 14:19

You know, you have somebody who's your accountability partner in all this and life and everything like that. I mean, this is not something that she thought she was signing up for when we met. I mean, she knew my history, but I don't think she fully understood it because, you know, there was an instance about four years ago where my father-in-law was visiting and he's on a new form of pain medication because of his many, many knee replacements and everything like that. And he's older, he's I heard him say the word at the dinner table, and I looked up the drug at on the Google machine that night, and I knew that there was this strong opiate medication in my house. Like, and it was immediate. I hadn't taken a drug forever. And I that night was backdooring everything and sneaking into the guest house, and my wife knew it was coming, and she beelined across the quad and she confronted me on it and she ended up saving my life because it the decision was made, it was done. Like, if I could have got those in my hand, it was over. Like, if it's in my house, no one's ever going to know. Yeah, and so people who didn't necessarily sign up for this have a really good understanding of what it is, and so both of those times, both of those instances where I've had to go through an invasive surgery she was put in charge of it, and I probably, you know, I think the one on my lower back was the one that I think maybe I had been two days on the pain medication. And then that was it. That was it. Yeah.

 Dr. Daryl Shorter: 15:53

And you were not taking Suboxone or any other kind of medication while you were getting your surgery done.?

Ryan Leaf: 15:59

Unfortunately for me, oh no, both of those instances. But the brain tumor came during the time of recovery where I was on Vivitrol.

Dr. Daryl Shorter: 16:10

Oh, okay.

Ryan Leaf: 16:11

So you have to carry that card with you in case you're in any sort of accident or anything like that, so the paramedics and the first responders can understand fully that, you know, this guy's pain threshold is going to be much higher than what somebody else's is.

Dr. Daryl Shorter: 16:25

And so just for our folks that are watching, it is important to note that if you are on an opioid blocker, an opioid medication like a Vivitrol, which is the injectable form that lasts for 30 days, or an Naltrexone, that it's going to require even higher doses of a pain medication in order to break through that opioid blocker. Same thing is true for Suboxone and Methadone as well.

Ryan Leaf: 16:44

And that was big for me to go into a brain surgery where I was going to be with an anesthesiologist and be under for, I think the surgery was 14 hours. Wow. So for the anesthesiologist to know that that was going to be much different with somebody who was on an opiate blocker. That's right. That was important to know. But then coming out of that surgery, we used no opiates coming out. It was all it was all um, you know, anti-inflammatory medication. Brain surgery was different than any sort of orthopedic surgery. Though this was incredibly invasive, there wasn't as much residual pain that came with it in comparison to the orthopedic ones. The pain receptors are a little different. Yeah, yeah. So it was not as much, though I remember sitting in that process thinking and almost making myself believe I was in more pain because I was in a controlled environment that maybe I could have that.

Dr. Daryl Shorter: 17:44

Let me ask another question. So, how much pre-preparation, pre-planning conversation did you have with your doctor, with your wife about all of this? Was it just like we're just kind of making it up as we go along, or was there a very intentional plan with the brain surgery?

Ryan Leaf: 18:05

It was very transparent because I was currently on Vivitrol. Right. So I was currently trying to stay sober and be in recovery and everything like that. So it was easy to do. Where I find it incredibly difficult to do is when you are in the throes of an addiction. Right? When I was going through the radiation process, I had relapsed, you know, before going into the radiation, and then you know, four weeks into the radiation of a six-week treatment, I was just done. I was like, I don't want to feel this anymore. And so, but going into it with that radiologist and my and my cancer doctor, like my cancer doctor knew, but they, I don't know if he didn't put it in the charts or didn't have that conversation with the radiologist, because I didn't say anything, knowing that God, I hope I  don't have to go through this process and feel it.

Dr. Daryl Shorter: 19:13

Yeah.

Ryan Leaf: 19:13

You know, so I really do think it's of the mindset of the person that they're where they're in at that point, and that's where doctors a lot of the times meet you where they are. You know, and that can be tough for doctors sometimes because they may not know. So you walk into any sort of situation always kind of trying to find the empathetic place that they're in and meet them there where they're at. And that makes a world of difference for an individual who may be hesitant to divulge that because you talked about the stigma and how one may be treated because of it.

Dr. Daryl Shorter: 19:42

Yeah. And I also think that we ultimately are trying to be collaborative partners in healthcare. And so sometimes that means that, as the doc, I have to pause and listen to what's being said, and so we can try to come up with a plan together. But, you know, in our healthcare system with the way it is right now, many of the challenges, you don't sometimes have the time for that. Maybe you're not always seeing the same person. Sometimes that's a luxury to actually even have the same doctor multiple times. Like you get to stick with people. So there can be a lot of barriers to that and challenges too.

Ryan Leaf: 20:13

So my wife and I are watching Downton Abbey right now. It's excellent. All right. So, well, if people don't know this, it's literally Game of Thrones, just more formal. It is horribly disturbing in every facet. But one of the things is, and it speaks to its understanding around doctors, is like it just no matter what time in our existence, doctors are human beings who have grown up in science and can have differing opinions about something. That's correct. Drastically. My primary care physician in Los Angeles had put me on Lysinopril for my high blood pressure and a lipitor for my heart, essentially. The hope is that you get back to a healthy place in your life where you don't have to take those anymore. And I remember going to him like, you know, my blood pressure is amazing. It's been amazing for this. Do you just think we should stop taking? He's like, no, it's working. And then I come to Connecticut where I am now, and I'm working with my new primary care physician, and we are now to a place where he's taking me off both my Lectopril and my Lipitor. And we, him and I are on the same wavelength in terms of like we're not preventing it anymore or trying to stop it. You've done the work necessary to now allow yourself not to have to take this every single day. And so that's always something that you talk to athletes a lot of times who go try to find second opinions around an injury or something like that. And I'm just for the longest time, I have been so faithful around science and doctors, and it's with this. The whole process with COVID and the vaccines and everything like that, and how doctors have pitted against one another. It's just really about finding the right fit where you are honest with your physician and they're honest with you, and you find the best course of treatment that works for you. And you can't, every experience is different. You can't lump everything into some broad subjective thing that, like, no, this is science. Yeah. And everybody who's under this, you know, ball or dome of science is it's the right way. You have to feel comfortable with it.

Dr. Daryl Shorter: 22:37

And I think what you're really getting to is the importance of communication and how that communication goes both ways. And the sort of core of it is honest communication, especially about your history, so that everybody in the set in the room can understand the individual's risk and how best to help in a situation like that.

Ryan Leaf: 22:56

And your belief system. Because my wife is constantly, we've talked about the births of both of our kids and how different each one was because of the physician and their willingness to go into it with the belief system of how my wife wanted to give birth. You know, how horrible the first one was to her because the doctor was just not interested in her process, and how the second doctor was so interested in her process to make it the best possible experience for her. I think that's a lot to do with bedside manner there. There's a ton to do with empathy. There's because there's plenty of different ways, you know, people use the line to skin a cat, well, or to deliver a baby.

Dr. Daryl Shorter: 23:44

Yeah.

Ryan Leaf: 23:45

And so that's opened my eyes to a lot of those things. And then the belief system of your primary care physician, I want to be on the same page with them. Like this, I would like to get to a place where I don't have to take this medication anymore.

Dr. Daryl Shorter: 23:57

Yeah, yeah.

Ryan Leaf: 23:58

Like the reason we started taking it was because of the fear around the high blood pressure and maybe a cardiovascular problem. And now those don't exist anymore. And it's not just because of the medication, the medication was preventative. The 180-degree lifestyle change is the reason why it no longer exists. Yeah, exactly. And so you want to be able to get to that place, and that's just to your point, true communication, volunteering information that is…listen, one of the charges I had was providing a false medical history. That's part of the doctor shopping aspect of things. It's illegal. Yeah.

Dr. Daryl Shorter: 24:37

So you've got to tell your truth to the doctor because it's illegal otherwise.

Ryan Leaf: 24:41

Otherwise, you go to jail, you go to prison. And submitting a false medical history is what it was. And what that was for me is saying I was not honest with the doctor. I was at another doctor yesterday getting pain medication. That was the lie I told. That I hadn't been at a doctor the day before. And so that for me has served me well over the last 13 years, simply being honest about it. Plain and simple. I'm not disgusted; I'm not ashamed by it. And I think a lot of times those individuals don't say something because of the guilt and shame that

comes with it and the stigma that that doctor may absolutely. And that's why you find a doctor that you just feel comfortable with. I mean, my new primary care physician that I found, and who's been my doctor now for the last three years, like, you know, we feel like we're in it together. Yeah. Like especially from where I was at to where I'm at now, that's important. We feel like we've done something together and we've achieved something together. And that's cool when you have a teammate in the process. And that's based in transparency and honesty and communication, like you talked about.

Dr. Daryl Shorter: 25:49

One final point I want to make sure that that we make today in managing if someone has a history of opioid use disorder, they're being managed on Suboxone and they have to have a planned surgery. One of the questions that frequently comes up when people consult me is: Do I have to stop my Suboxone in order to get my surgery? Or the doctor's like, Hey, should I stop the Suboxone because they're about to have surgery? 

 The answer is no, you do not have to stop your Suboxone. You do not have to stop your Suboxone in order to have a surgical procedure. And the reason is because, in order to put somebody back on the Suboxone, they have to go into withdrawal. You don't want to do that to someone in order to get them restarted on their Suboxone. You've actually destabilized their opioid use disorder treatment by stopping the medication. So you treat the OUD as well as the surgery, you treat through it.

Ryan Leaf: 26:37

And that is something that needs to be talked about and understood in the medical field because when we were going through the process, there were many of the doctors are saying to have surgery, you have to be off this medication. And that is needed to be better communicated

to those individuals because usually when the surgery that you're having, if it's not an emergency in nature, this is something that can be discussed, and the more important thing is for you to continue with your recovery.

Dr. Daryl Shorter: 27:09

Yeah.

Ryan Leaf: 27:09

Right? You know, an orthopedic surgery or a cosmetic surgery or something like that, those things aren't what is going to affect your longevity in life like the recovery basis and treatment basis of what you're going through. So that's good information to know. You do not have to go off your recovery aid, whether that be Vivitrol, Suboxone, all those things, if you are being wheeled into surgery. You just have to be honest about it. That's right.

 Dr. Daryl Shorter: 27:40

And we're going to be honest with you, we'll be back. And we look forward to next time. Next time.