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Many Patients Don't Need Opioids After Surgery

MONDAY, June 3, 2019 -- The opioid epidemic has been fueled in part by the overprescribing of painkillers. But a new study finds that up to half of patients may not actually need the addictive pills following a surgery.

The finding could be a game-changer for post-op care, said lead researcher Dr. Michael Englesbe.

"We think a fundamental root cause of the opioid epidemic is opioid-naive patients getting exposed to opioids and then really struggling to stop taking them post-operatively," said Englesbe, a professor of surgery at the University of Michigan in Ann Arbor.

If patients find that they can't wean themselves off the opioid, that can quickly escalate to "chronic opioid use, abuse, addiction and overdose," he said in a university news release.

So, since 2010, doctors have been urged to prescribe fewer narcotic painkillers. According to the researchers, primary care doctors have heeded the call, but prescriptions by surgeons actually rose 18% between 2010 and 2016.

But do surgical patients need all those opioids?

To find out, Englesbe and colleagues conducted a pilot study of pain management after six surgical procedures.

They found that more than half of patients simply didn't need post-op opioids to manage their pain.

A total of 190 patients, all new to opioids, were included in the study. They underwent one of six types of operations: gallbladder, thyroid, hernia, prostate, sinus or weight-loss surgery.

To manage their pain, patients were given prescriptions for acetaminophen (one brand name is Tylenol) and ibuprofen, plus a small "rescue" prescription of the opioid oxycodone (one brand name is OxyContin) if needed.

Patients were told to take acetaminophen or ibuprofen every six hours and to stagger these drugs by three hours.

In the week following surgery, patients were asked to rate their pain on a scale of 0 to 3, with 0 being no pain and 3 severe pain.

Between 30 and 90 days after surgery, patients were also asked how many opioids they took.

The researchers found that more than half (52%) of patients didn't use any opioids at all. The 48% who used opioids took an average of just four pills. The average pain score for all patients was 1, and for those who took opioids it was 2.

Most patients also said they were "extremely satisfied" with their treatment.

Englesbe stressed that "just not giving opioids is not the answer -- we have to give the best pain care. From the beginning, everyone was on the same page with talking to patients about their pain and letting them know that operations hurt.

"Our goal is to have half the operations done without patients needing opioids and still getting excellent pain care, Englesbe said. "There are alternatives to opioids for surgical pain that work well and we should be using them more."

One pain specialist who wasn't involved in the study said the findings were "remarkable."

"It challenges prevailing beliefs of the very role opioids need to play in effective pain management," said Dr. Harshal Kirane. He directs addiction services at Staten Island University Hospital in New York City.

"Judicious opioid management is increasingly a shared responsibility between prescribers and patients," Kirane said. He said there are "useful options to alleviate pain" that extend beyond opioids, "ranging from medications to non-pharmacologic alternatives."

The report was published online May 31 in the Journal of the American College of Surgeons.

More information

The American Society of Anesthesiologists offers more information on managing post-surgical pain.

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Posted: June 2019

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