Are We Prescribing Our Patients Too Much Pain Medication?

Grant, Daniel R.; Schoenleber, Scott J.; McCarthy, Alicia; Neiss, Geraldine; Yorgova, Petya; Rogers, Kenneth; Gabos, Peter G.; Shah, Suken A.

doi:10.2106/jbjs.16.00101

Cited by 50 publications

(29 citation statements)

References 22 publications

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“…Individualized prescriptions for postoperative opioid use, based on predictive modeling of known influential factors, could help us to better define expected use, potentially eliminating leftover medication and refill requests. However, our findings corroborate past research, 3,4,26 concluding that postoperative opioid consumption is difficult to predict. While there is substantial evidence 12,23 behind factors associated with the development of chronic opioid consumption or long-term use, these factors (male sex, depression, chronic back pain, and preoperative opioid use) have not been consistently borne out as risk factors for increased immediate postoperative consumption.…”

Section: Discussionsupporting

confidence: 91%

“…12,22 Interestingly, no study, including ours, has found an association between adjunct analgesics (nonsteroidal anti-inflammatory medications, acetaminophen, or gabapentin) and total opioid consumption after discharge. 3,4,26 While a lack of power may explain the largely negative findings of ours and others on predictors of increased postoperative opioid use, another potential explanation is that we do not understand, or are not accurately capturing, the drivers behind postoperative opioid consumption. Over the first postoperative week, the median NRS pain scores and opioid consumption both decreased (see Figure 3).…”

Section: Discussionmentioning

confidence: 60%

“…Two studies found that male sex and postoperative pain levels were associated with narcotic consumption (of note, 1 study was in a pediatric population), whereas another study reported associations with smoking and preoperative opioid use in the month before surgery. 3,4,26 Notably, ours is the first to report a significant association with history of a psychiatric disorder (P ¼ .022), one of the factors most commonly reported in studies on chronic opioid Defined as above or below the median use (3 oxycodone 5-mg pills, 22.5 OME). Data are expressed as n (%), unless otherwise indicated.…”

Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

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Opioid Consumption After Arthroscopic Meniscal Procedures and Anterior Cruciate Ligament Reconstruction

Lovecchio

Premkumar

Uppstrom

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Procedure-specific opioid-prescribing guidelines have the potential to decrease the number of unused pills in the home without compromising patient satisfaction. However, there is a paucity of data on the minimum necessary quantity to prescribe for outpatient orthopaedic surgeries. Purpose: To prospectively record daily opioid use and pain levels after arthroscopic meniscal procedures and anterior cruciate ligament reconstruction (ACLR) at a single institution. Study Design: Case series; Level of evidence, 4. Methods: A total of 95 adult patients who underwent primary arthroscopic knee surgery (meniscectomy, repair, or ACLR) were enrolled. Patients with a history of opioid dependence were ineligible. Daily opioid consumption and Numeric Rating Scale pain scores were collected through an automated text-messaging platform starting on postoperative day 1 (POD1). At 6 weeks or at patient-reported cessation of opioid use, final survey questions were asked. Patients who failed to complete data collection were excluded. Opioid use was converted into “pills” (oxycodone 5-mg equivalents) to facilitate comparisons and clinical applications. Factors associated with high and low opioid use were compared. Results: Of the 95 patients enrolled, 71 (74.7%) were included in the final analysis. Of these, 40 (56.3%) underwent meniscal surgery and 31 (43.7%) underwent ACLR. After outpatient arthroscopic meniscectomy or repair, the total median postdischarge opioid use was 0.3 pills (oxycodone 5-mg equivalents), with 75% of patients consuming 3.3 or fewer pills (range, 0-19 pills). For ACLR, the median postdischarge consumption was 7 pills (75th percentile, 23.3 pills; range, 0-41 pills). Almost one-third of patients (32.3%) took no opioids after surgery (3 ACLR, 20 meniscus). All meniscus patients and 71% of ACLR patients ceased opioid consumption by postoperative day 7. Conclusion: Opioids may not be necessary in all patients, particularly after meniscal surgery and in comparison with ACLR. For patients requesting opioids for pain relief, reasonable prescription quantities are 5 oxycodone 5-mg pills after arthroscopic meniscal procedures and 20 5-mg pills after ACLR. Slowing the current opioid epidemic and preventing future crises is dependent on refining prescribing habits. Clinicians should strongly consider patient education regarding expected pain as well as pain management strategies.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Opioid Consumption After Arthroscopic Meniscal Procedures and Anterior Cruciate Ligament Reconstruction

Lovecchio

Premkumar

Uppstrom

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…The effect of sex on chronic opioid use has thus far been equivocal. Studies have identified both female 1,17 and male 12,39 sex as a potential risk factor; however, in other studies, no associations between long-term opioid use and sex have been found. 14,28,34 Although the effect of sex on chronic opioid use is still ambiguous, evidence indicates that women are more likely to report chronic pain issues and opioid dependence.…”

Section: Discussionmentioning

confidence: 90%

Elective Shoulder Surgery in the Opioid Naïve: Rates of and Risk Factors for Long-term Postoperative Opioid Use

et al. 2019

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Background: Little is known regarding the rates and risk factors for long-term postoperative opioid use among opioid-naïve patients undergoing elective shoulder surgery. Purpose: To identify (1) the proportion of opioid-naïve patients undergoing elective shoulder surgery, (2) the rates of postoperative opioid use among these patients, and (3) the risk factors associated with long-term postoperative opioid use. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of a private administrative claims database was performed to identify those individuals who underwent elective shoulder surgery between 2007 and 2015. “Opioid-naïve” patients were identified as those patients who had not filled an opioid prescription in the 180 days before the index surgery. Within this subgroup, we tracked postoperative opioid prescription refill rates and used a logistic regression to identify patient variables that were predictive for long-term opioid use, which we defined as continued opioid refills beyond 180 days after surgery. Results were reported as odds ratios (ORs). Results: Over the study period, 79,287 patients were identified who underwent elective shoulder surgery, of whom 79.5% were opioid naïve. Among opioid-naïve patients, the rate of postoperative opioid use declined over time, and 14.6% of patients were still using opioids beyond 180 days. The greatest proportion of opioid-naïve patients still filling opioid prescriptions beyond 180 days postoperatively was seen after open rotator cuff repair (20.9%), whereas arthroscopic labral repair had the lowest proportion (9.8%). Overall, a history of alcohol abuse (OR 1.56), a history of depression (OR 1.46), a history of anxiety (OR, 1.31), female sex (OR, 1.11), and higher Charlson Comorbidity Index (OR 1.02) had the most significant influence on the risk for long-term opioid use among opioid naïve patients. Conclusions: Most patients were opioid naïve before elective shoulder surgery; however, among opioid-naïve patients, 1 in 7 patients were still using opioids beyond 180 days after surgery. Among all variables, a history of mental illness most significantly increased the risk of long-term opioid use after elective shoulder surgery.

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A prospective observational study of pediatric opioid prescribing at postoperative discharge: how much is actually used?

Caldeira-Kulbakas

Stratton

Roy

et al. 2020

Can J Anesth/J Can Anesth

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Purpose Research describing opioid misuse in children after surgery currently describes single specialties, short follow-up, and heterogeneous data not conducive to comparative discussion. Our primary objective was to quantify opioids prescribed to pediatric surgical patients on discharge from hospital. Secondary objectives were quantifying opioids remaining unused at four-week followup, and family attitudes to safe storage and disposal. Methods We conducted a prospective observational study under counterfactual consent with telephone follow-up at four weeks of children who had undergone a surgical procedure and filled an opioid prescription at The Hospital for Sick Children, Toronto, ON, Canada. Exclusion criteria included opioid use within the previous six months, history of chronic pain, or discharge to a rehabilitation facility. Pre-and post-discharge prescribing, dispensing, and consumption data were collected prospectively in addition to parental reports of home opioid use. Opioiddosing was converted to oral morphine milligram equivalents (MME). Results There were 8,672 MMEs prescribed to 110 patients. Twenty-one patients were lost to follow-up, accounting for 1,416 MME. Of the remaining 7,256 MME, 67% went unused. At follow-up, 78% of unused opioid remained in the home. Most opioids were stored in an easily accessible location in the home. Conclusion These findings confirm overprescribing of opioids to pediatric surgical patients. Families tend not to return opioids that exceed post-discharge analgesic requirements at home and many of the reported disposal methods are unsafe. We recommend future studies focus on optimizing opioid prescriptions to meet, but not excessively surpass, home pain management requirements, and to encourage safe opioid disposal/return methods. Trial registration www.clinicaltrials.gov (NCT03562013); registered 7 June, 2018. Re ´sumeÓbjectif La recherche s'inte ´ressant a `la mauvaise utilisation des opioı ¨des apre `s une chirurgie chez des enfants de ´crit actuellement des spe ´cialite ´s uniques, un suivi de courte dure ´e et des donne ´es he ´te ´roge `nes ne permettant pas de de ´boucher sur un de ´bat comparatif. Notre objectif principal e ´tait de quantifier les opioı ¨des prescrits a `des patients chirurgicaux pe ´diatriques au moment de leur conge ´de l'ho ˆpital. Les objectifs secondaires e ´taient de quantifier les opioı ¨des inutilise ´s restant apre `s quatre

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Are We Prescribing Our Patients Too Much Pain Medication?

Abstract: Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

Cited by 50 publications

References 22 publications

Opioid Consumption After Arthroscopic Meniscal Procedures and Anterior Cruciate Ligament Reconstruction

Opioid Consumption After Arthroscopic Meniscal Procedures and Anterior Cruciate Ligament Reconstruction

Elective Shoulder Surgery in the Opioid Naïve: Rates of and Risk Factors for Long-term Postoperative Opioid Use

A prospective observational study of pediatric opioid prescribing at postoperative discharge: how much is actually used?

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