Nav: Home

More than half of patients in pain management study took no opioids after operations

May 31, 2019

CHICAGO (May 31, 2019): The opioid epidemic has become a public health crisis in the U.S. While primary care physicians have been writing fewer opioid prescriptions over the last several years, new opioid prescriptions by surgeons increased 18 percent from 2010-2016.* However, many surgeons are now diligently working to change their prescribing practices. One approach has been to try reducing excessive opioid prescriptions by exploring pain management strategies that include fewer or no opioids at all for surgical patients.


One study team at the University of Michigan wanted to find out if an opioid-sparing strategy would be feasible for patients undergoing six different procedures at their institution. Results from their pilot study showed that more than half of patients used no opioids after their operations, and almost all of the patients reported their pain was manageable, according to study findings published as an "article in press" on the website of the Journal of the American College of Surgeons ahead of print.


The study team, led by Michael Englesbe, MD, FACS, has been working to improve opioid prescribing in Michigan for two years. Their work is motivated by the fact that many people not taking opioids before their operations ("opioid-naïve") become new chronic opioid users after their operations, said Dr. Englesbe, the study's corresponding author and a professor of surgery at the University of Michigan, Ann Arbor.


"We think a fundamental root cause of the opioid epidemic is opioid-naïve patients getting exposed to opioids and then really struggling to stop taking them postoperatively, and then moving on to chronic opioid use, abuse, addiction, and overdose," Dr. Englesbe said. For this study, the goal was to have a majority of patients need no opioid pills after their operations.


The researchers enrolled 190 opioid-naïve patients undergoing six surgical procedures at their institution: laparoscopic cholecystectomy, laparoscopic inguinal hernia repair, thyroidectomy/parathyroidectomy, robotic prostatectomy, endoscopic sinus operations, and laparoscopic sleeve gastrectomy. Participants received specific instructions regarding postoperative pain control, pain expectations, and counseling to learn to manage pain without opioids. At their preoperative clinic visits, patients were told to take acetaminophen or ibuprofen every six hours around the clock and to stagger these medications every three hours for maximum continuous pain control.


After their operations, patients received prescriptions for 650 mg of acetaminophen and 600 mg of ibuprofen, as well as a small "rescue" prescription of opioids for uncontrolled breakthrough pain. The prescription sizes of opioids--mostly oxycodone--varied based on the operation but were small. For example, laparoscopic cholecystectomy patients were prescribed four oxycodone pills. Patients were instructed during both their preoperative and postoperative clinic visits that they didn't have to use the opioids if they didn't feel they needed to.


During the first week after their operations, patients were asked to rate their average pain score on a scale of no pain (0) to severe pain (3). They were also asked to rate their surgical site pain at the time of the survey, their satisfaction with the operation, their quality of life after the operation, the percent recovered they felt at the time of the survey, and whether they regretted having the operation. Patients also reported whether they used acetaminophen and/or ibuprofen, and whether their pain was manageable with this regimen. Between 30 and 90 days after their operations, patients were asked to report the number of opioid pills they used postoperatively.


The study authors reported that 52 percent of patients used no opioids after their operations at all, and 98 percent used 10 pills or fewer. Among the 48 percent of patients who did use opioids, the median use was four pills, and the median number of leftover pills was two. The median pain score for the whole cohort was 1, or minimal pain; that number was 2 for patients who used opioids. Overall, the median patient satisfaction score was 10 on a 10-point scale, or extremely satisfied, and the median quality of life score was 4 on a 5-point scale. The median level of regret to undergo the operation was 5 ("absolutely no regret"). There were no significant differences in the other variables when comparing opioid users with non-users, the authors reported. Almost all patients--91 percent--said their pain was manageable using this strategy.


While Dr. Englesbe said it was a bit surprising--and very motivating--that a significant percentage of patients took no opioids, it's also important to understand that fewer opioids are only one component of the larger pain management strategy. The focus has to be on what does work, which will not be the same for every patient.


"Just not giving opioids is not the answer--we have to give the best pain care," Dr. Englesbe said. In the case of this study, the team provided a full care pathway. "From the beginning, everyone was on the same page with talking to patients about their pain and letting them know that operations hurt," he added.


With the help of funding from Blue Cross Blue Shield of Michigan and the Michigan Department of Health and Human Services, Dr. Englesbe and his team are in the process of expanding this pain management strategy. They will expand their list of selected surgical procedures from six to 18 and are working to implement the strategy to other institutions across the state.


"Our overall goal is to have half the operations done in the state of Michigan without patients needing opioids and still getting excellent pain care," Dr. Englesbe said. "There are alternatives to opioids for surgical pain that work well and we should be using them more."
-end-
Dr. Englesbe's coauthors were Alexander Hallway, BS; Joceline Vu, MD; Jay Lee, MD; William Palazzolo, PA-C; Jennifer Waljee, MD, MS, MPH; Chad Brummett, MD; and Ryan Howard, MD, of the University of Michigan Health System.


Acknowledgements: The authors have no relevant conflicts of interest to disclose. Funding for this project was obtained from the Blue Cross Blue Shield of Michigan Foundation and the Michigan Department of Health and Human Services. AH, ME, and RH had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.


"FACS" designates that a surgeon is a Fellow of the American College of Surgeons.


Citation: Postoperative Opioid-Sparing Pathway Does Not Compromise Patient Satisfaction or Pain Control. Journal of the American College of Surgeons. Available at: https://doi.org/10.1016/j.jamcollsurg.2019.04.020.

* Larach DB, Waljee JF, Hu HM, et al. Patterns of Initial Opioid Prescribing to Opioid-Naive Patients. Ann Surg. 2018.

About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 82,000 members and is the largest organization of surgeons in the world. For more information, visit http://www.facs.org (.)

American College of Surgeons

Related Pain Articles:

Pain researchers get a common language to describe pain
Pain researchers around the world have agreed to classify pain in the mouth, jaw and face according to the same system.
It's not just a pain in the head -- facial pain can be a symptom of headaches too
A new study finds that up to 10% of people with headaches also have facial pain.
New opioid speeds up recovery without increasing pain sensitivity or risk of chronic pain
A new type of non-addictive opioid developed by researchers at Tulane University and the Southeast Louisiana Veterans Health Care System accelerates recovery time from pain compared to morphine without increasing pain sensitivity, according to a new study published in the Journal of Neuroinflammation.
The insular cortex processes pain and drives learning from pain
Neuroscientists at EPFL have discovered an area of the brain, the insular cortex, that processes painful experiences and thereby drives learning from aversive events.
Pain, pain go away: new tools improve students' experience of school-based vaccines
Researchers at the University of Toronto and The Hospital for Sick Children (SickKids) have teamed up with educators, public health practitioners and grade seven students in Ontario to develop and implement a new approach to delivering school-based vaccines that improves student experience.
Pain sensitization increases risk of persistent knee pain
Becoming more sensitive to pain, or pain sensitization, is an important risk factor for developing persistent knee pain in osteoarthritis (OA), according to a new study by researchers from the Université de Montréal (UdeM) School of Rehabilitation and Hôpital Maisonneuve Rosemont Research Centre (CRHMR) in collaboration with researchers at Boston University School of Medicine (BUSM).
Becoming more sensitive to pain increases the risk of knee pain not going away
A new study by researchers in Montreal and Boston looks at the role that pain plays in osteoarthritis, a disease that affects over 300 million adults worldwide.
Pain disruption therapy treats source of chronic back pain
People with treatment-resistant back pain may get significant and lasting relief with dorsal root ganglion (DRG) stimulation therapy, an innovative treatment that short-circuits pain, suggests a study presented at the ANESTHESIOLOGY® 2018 annual meeting.
Sugar pills relieve pain for chronic pain patients
Someday doctors may prescribe sugar pills for certain chronic pain patients based on their brain anatomy and psychology.
Peripheral nerve block provides some with long-lasting pain relief for severe facial pain
A new study has shown that use of peripheral nerve blocks in the treatment of Trigeminal Neuralgia (TGN) may produce long-term pain relief.
More Pain News and Pain Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Making Amends
What makes a true apology? What does it mean to make amends for past mistakes? This hour, TED speakers explore how repairing the wrongs of the past is the first step toward healing for the future. Guests include historian and preservationist Brent Leggs, law professor Martha Minow, librarian Dawn Wacek, and playwright V (formerly Eve Ensler).
Now Playing: Science for the People

#565 The Great Wide Indoors
We're all spending a bit more time indoors this summer than we probably figured. But did you ever stop to think about why the places we live and work as designed the way they are? And how they could be designed better? We're talking with Emily Anthes about her new book "The Great Indoors: The Surprising Science of how Buildings Shape our Behavior, Health and Happiness".
Now Playing: Radiolab

The Third. A TED Talk.
Jad gives a TED talk about his life as a journalist and how Radiolab has evolved over the years. Here's how TED described it:How do you end a story? Host of Radiolab Jad Abumrad tells how his search for an answer led him home to the mountains of Tennessee, where he met an unexpected teacher: Dolly Parton.Jad Nicholas Abumrad is a Lebanese-American radio host, composer and producer. He is the founder of the syndicated public radio program Radiolab, which is broadcast on over 600 radio stations nationwide and is downloaded more than 120 million times a year as a podcast. He also created More Perfect, a podcast that tells the stories behind the Supreme Court's most famous decisions. And most recently, Dolly Parton's America, a nine-episode podcast exploring the life and times of the iconic country music star. Abumrad has received three Peabody Awards and was named a MacArthur Fellow in 2011.