Pain, Pain, Go Away

A new non-opioid painkiller is easing plastic surgery recovery

If you have a plastic surgery procedure on the calendar, your physician should be talking to you about pain management—the medley of medications they provide before, during, and after surgery to make recovery as comfortable as possible.

Photo by Alexander Grey on Unsplash

While doctors have collectively been moving away from opioids—in order to curb rates of addiction and overdose and to lessen the side effects of these drugs, which board-certified plastic surgeon Daniel J. Gould, MD, PhD, describes as “the worst thing about surgery”—it’s not unusual for surgeons to still prescribe a limited number of, say, Percocet as a last-resort measure for easing periods of peak discomfort. But as more non-opioid drug options come to market, patients are generally relying less on narcotics and enjoying smoother recoveries.

One such drug is Journavx (suzetrigine), which was FDA approved in January 2025, following two successful clinical trials. The company tested the medication in patients who’d had tummy tucks and, separately, bunion removal surgery, and found it relieved post-op pain as effectively as Vicodin. According to the FDA, “Journavx reduces pain by targeting a pain-signaling pathway involving sodium channels in the peripheral nervous system, before pain signals reach the brain.” It’s also “the first drug to be approved in this new class of pain management medicines” dubbed pain-signal inhibitors.

Dr. Gould has been using Journavx in practice for about three months now. In detailing his early experience with the drug, he told me about a male patient who had a facelift plus a tummy tuck with 360 liposuction and ab etching—a combination that would prompt most people to take at least 10 Percocet following surgery, mainly to alleviate the lipo-related discomfort. In this case, though, Dr. Gould started his patient on Journavx the day after surgery (when he first complained of pain), “and within an hour or two, he was like, ‘Wow, the pain is pretty much gone,’” says Dr. Gould. The patient took only two Percocet total during recovery.

Journavx has a fascinating origin story. Its development was inspired by a group of Pakistani fire walkers, who could not feel pain, due to a rare mutation in a gene called SCN9A. “This is the gene that codes one of the sodium channels,” Dr. Gould says. Sodium channels are proteins in the membranes of nerve cells that facilitate the flow of sodium ions into the cells and “allow for the transmission of electrical impulses through nerves,” he explains.

In the pain-immune Pakistanis—a handful of individuals, all related—there was a “loss-of-function mutation in the gene that makes a very specific sodium channel that's critical for pain [signaling] in peripheral nerves,” Dr. Gould says. “Without that sodium channel, they have dramatically blunted pain, but they still have other sensations, because it’s not affecting the nerves that sense touch or pressure.”

The minds behind Journavx realized that by inhibiting this one sodium channel, they could inhibit pain. The drug is “basically stopping the transmission of the pain signal at the level of the neuron,” says Dr. Gould, preventing it from reaching the brain. Blocking this one channel stymies pain without the drawbacks of opioids—the nausea, constipation, euphoria, sedation, respiratory depression, and risk of addiction. Opioids have such sweeping effects because of how they work in the brain, he adds, whereas Journavx “acts very peripherally and selectively and just goes after the pain.”

Since Journavx seems to have an impressive safety profile with “minimal side effects” and “no evidence of addiction or rebound pain” (intense pain that occurs when a drug wears off), Dr. Gould prescribes it routinely to his surgical patients, finding it especially beneficial for those having procedures with typically high pain ratings, like reverse abdominoplasties (which involve suturing the deep fascia to the ribs) as well as certain breast surgeries (namely ones that elevate the breast fold), 360 liposuction cases, body lifts, and traditional tummy tucks.

In Dr. Gould’s practice, the drug has also been “game changing” for patients undergoing spicy nonsurgical treatments, like RF microneedling and certain lasers, sometimes obviating the need for opioids or sedatives.

Still, since Journavx is new, Dr. Gould urges fellow doctors to be mindful of potential drug interactions and to start out (as he did) by prescribing it only to patients who aren’t taking any long-term medications. He also notes that, as with any drug, there’s always a risk of allergic reactions and anaphylaxis.

In most cases, Journavx is just one instrument in a symphony of analgesics. Prior to surgery, Dr. Gould uses it in concert with gabapentin (which targets nerve pain), intravenous or oral Tylenol, and the anti-nausea medication Emend. During surgery, he’ll typically inject a cocktail of bupivacaine and lidocaine (both local anesthetics) followed by, in select cases, Exparel, a long-acting anesthetic that’s commonly injected directly into the fascia overlying the abdominal muscles during tummy tucks. Post-op, Dr. Gould provides patients with more Journavx, gabapentin, and Tylenol, plus a narcotic (like Percocet or Demerol) to be taken only if needed. “Better to have it and not need it, than need it and not have it,” he says. All told, he notes, this pain-control protocol is lessening the amount of opioids used during and after surgery.

Another plus: Journavx is pretty affordable. Ordinarily, painkillers can add hundreds of dollars to the total cost of surgery. “This is the biggest issue I have with most pain medications, especially the newer ones—they tend to be super-expensive,” says Dr. Gould. Emend, the aforementioned nausea-prevention drug, costs $100 per pill. Injectable Exparel is around $340 per vial. Journavx is covered by insurance in most cases, he says. “And when it’s not, the company offers a coupon, so it’s only 30 bucks for a month’s supply.”

For the record, Dr. Gould does not have a relationship with Vertex, the company that makes Journavx. He is conducting a small prospective study of the drug, but Vertex is not funding the trial. While results are still pending, he tells me, “at this point, what I can say is that I haven't seen a medication like this in a long time.”

On a somewhat related note, a reader reached out to share her honest review of Miria, a new laser that claims to resurface, tighten, and plump the skin:

“Everything I was told about the results has been pretty accurate. It took about five days for all the swelling to go down. The redness has lasted a little longer for me, but it is slowly going away. I’m noticing a definite improvement in tone and texture. It gets a little better every day, but I think I’m taking a little longer [to recover] because of my reaction to the treatment: It HURT. All the literature says it’s not painful. That’s the only thing I’ve found to not be true for me. It was painful. It’s not going to stop me from getting the second session, but I’m forewarned now and may take three or four Advil before the session.”

Might this be a case for Journavx? Possibly. But according to Dr. Gould, the drug isn’t yet being widely used in aesthetics. Still, it may be worth exploring. (Before taking any new medication, it’s important to disclose every drug you’re currently taking and ask about all potential side effects and contraindications.)

This reader just pinged me with another Miria update: “It’s been two weeks now and I am very happy with the progress I’m seeing. My face is much clearer in terms of tone, texture, and pore size, and the spots I want gone are definitely fading.” She goes on to say, “I waited for three years to get some things taken care of for myself and I can’t tell you how much of an impact this has had on my mood and self-esteem. As far as the pain goes, I’ve talked about this to the PA and she said that I was right and that anyone who tells you it’s not painful is fibbing.”

Her full comments on the post are public if you’d like more details.

While I so value reader intel and find these truths enormously illuminating, let’s keep in mind that pain is a very subjective and personal experience. Of course, if you are on the sensitive side, you may want to talk to your healthcare professional about ways to mitigate discomfort during treatment.

Lastly, I just want to remind everyone that I do not accept money from pharmaceutical companies, beauty brands, or healthcare professionals to plug their offerings. I have been approached by brands wanting to sponsor my Substack, but since I rarely write about products and I use very few on my own face, I can’t imagine a promotional post ever feeling organic or genuine, so I’ve always declined such opportunities. That said, I am seeing more Substackers engage in this sort of advertising—I get it: I could certainly use the cash—so I’m curious how you feel about it. Is it NBD? Or might it cause you to question a writer’s intentions and integrity?

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