Bariatric Surgery Patients’ Response to a Chronic Pain Rehabilitation Program

Tabibian, Anilga; Grothe, Karen; Mundi, Manpreet S.; Kellogg, Todd A.; Clark, Matthew M.; Townsend, Cynthia O.

doi:10.1007/s11695-015-1634-6

Cited by 7 publications

(3 citation statements)

References 35 publications

(59 reference statements)

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“…In addition, there is high comorbidity between depression and addiction (Koob, 2008; Kosten et al, 1998; Markou et al, 1998) and there is a higher prevalence of depression in the bariatric surgery population (Bocchieri et al, 2002; Burgmer et al, 2007). A recent study (Tabibian et al, 2015) examined bariatric surgery patients’ response to a chronic pain rehabilitation program compared to non-bariatric patients with chronic pain. At discharge from the pain management program, bariatric patients demonstrated significantly higher scores for emotional concerns and were taking more morphine on an equivalent dose basis (+44%) as well as benzodiazepines and were less likely to complete treatment compared to controls.…”

Section: Discussionmentioning

confidence: 99%

Increased intravenous morphine self-administration following Roux-en-Y gastric bypass in dietary obese rats

Biegler

Freet

Horvath

et al. 2016

Brain Research Bulletin

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Roux-en-Y gastric bypass (RYGB) surgery is a commonly performed and very effective method to achieve significant, long-term weight loss. Opioid analgesics are primarily used to manage postoperative pain as fewer alternative medication options are available for bariatric surgery patients than for the general population. Recent clinical studies support a greater risk for substance use following bariatric surgery, including an increased use of opioid medications. The present study is the first to study morphine self-administration in a rat model of RYGB. High fat diet-induced obese (HFD-DIO) rats underwent RYGB (n=14) or sham-surgery with ad libitum HFD (SHAM, n=14) or a restricted amount that resulted in weight matched to the RYGB cohort (SHAM-WM, n=8). An additional normal-diet (ND, n=7), intact (no surgery) group of rats was included. Two months after the surgeries, rats were fitted with jugular catheters and trained on a fixed ratio-2 lick task to obtain morphine intravenously. Both morphine-seeking (number of licks on an empty spout to obtain morphine infusion) and consumption (number of infusion) were significantly greater in RYGB than any control group beginning on Day 3 and reached a two-fold increase over a period of two weeks. These findings demonstrate that RYGB increases motivation for taking morphine and that this effect is independent of weight loss. Further research is warranted to reveal the underlying mechanisms and to determine whether increased morphine use represents a risk for opioid addiction following RYGB. Identifying risk factors preoperatively could help with personalized postoperative care to prevent opioid abuse and addiction.

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Section: Discussionmentioning

confidence: 99%

Increased intravenous morphine self-administration following Roux-en-Y gastric bypass in dietary obese rats

Biegler

Freet

Horvath

et al. 2016

Brain Research Bulletin

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“…Insufficient data exist regarding the development of chronic pain following bariatric surgery, and the actual pain intensity [20]. Excessive weight loss may intensely improve e.g.…”

Section: Prevalencementioning

confidence: 99%

Chronic abdominal pain and persistent opioid use after bariatric surgery

Simoni

Ladebo

Christrup

et al. 2019

Scandinavian Journal of Pain

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Background and aimsBariatric surgery remains a mainstay for treatment of morbid obesity. However, long-term adverse outcomes include chronic abdominal pain and persistent opioid use. The aim of this review was to assess the existing data on prevalence, possible mechanisms, risk factors, and outcomes regarding chronic abdominal pain and persistent opioid use after bariatric surgery.MethodsPubMed was screened for relevant literature focusing on chronic abdominal pain, persistent opioid use and pharmacokinetic alterations of opioids after bariatric surgery. Relevant papers were cross-referenced to identify publications possibly not located during the ordinary screening.ResultsEvidence regarding general chronic pain status after bariatric surgery is sparse. However, our literature review revealed that abdominal pain was the most prevalent complication to bariatric surgery, presented in 3–61% of subjects with health care contacts or readmissions 1–5 years after surgery. This could be explained by behavioral, anatomical, and/or functional disorders. Persistent opioid use and doses increased after bariatric surgery, and 4–14% initiated a persistent opioid use 1–7 years after the surgery. Persistent opioid use was associated with severe pain symptoms and was most prevalent among subjects with a lower socioeconomic status. Alteration of absorption and distribution after bariatric surgery may impact opioid effects and increase the risk of adverse events and development of addiction. Changes in absorption have been briefly investigated, but the identified alterations could not be separated from alterations caused solely by excessive weight loss, and medication formulation could influence the findings. Subjects with persistent opioid use after bariatric surgery achieved lower weight loss and less metabolic benefits from the surgery. Thus, remission from comorbidities and cost effectiveness following bariatric surgery may be limited in these subjects.ConclusionsPain, especially chronic abdominal, and persistent opioid use were found to be prevalent after bariatric surgery. Physiological, anatomical, and pharmacokinetic changes are likely to play a role. However, the risk factors for occurrence of chronic abdominal pain and persistent opioid use have only been scarcely examined as have the possible impact of pain and persistent opioid use on clinical outcomes, and health-care costs. This makes it difficult to design targeted preventive interventions, which can identify subjects at risk and prevent persistent opioid use after bariatric surgery. Future studies could imply pharmacokinetic-, pharmacodynamics-, and physiological-based modelling of pain treatment. More attention to social, physiologic, and psychological factors may be warranted in order to identify specific risk profiles of subjects considered for bariatric surgery in order to tailor and optimize current treatment recommendations for this population.

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“…Abdominal discomfort might be a problem, as a pre-existing chronic condition or as surgeryrelated pain [8]. CPSP of the surgical site after bariatric surgery has been reported in up to 50% of the patients [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Peri-operative pain in patients experiencing bariatric surgery

Kumar¹,

Soekarman²,

Singh³

et al. 2017

Med Clin Arch

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A review of the literature was performed to identify follow-up studies on pain and bariatric surgery (gastric band, gastric sleeve or R-en-Y gastric bypass) as intervention. The main objective of this study was to find information on the prevalence of chronic pain in patients undergoing any of the mentioned surgical techniques and the incidence of chronic postsurgical pain after bariatric surgery.16 studies were included for further analysis with over 2000 subjects. 2/3 of the information was on bypass surgery. "Short term" studies with data on pain within 3 months after surgery were randomized controlled trials (RCTs) comparing surgical techniques or analgesia. Pre-operative pain status had not been documented. However, peri-operative pain management was reported in detail. In 8 observational studies, pain data were available exceeding 3 months after surgery ("long term" studies). While pre-operative pain data were reported in the latter studies, in over half the anatomic location of the pain had not been specified. An accurate estimation of the incidence of chronic postsurgical pain after bariatric surgery was not possible based on the available data. The number of comparable studies was low and the anatomic location of the pain had not been specified. Data on pain between 1 week and 6 months after surgery are lacking. This period is important, since it contains the time point after which the measured pain can be defined as chronic.

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Bariatric Surgery Patients’ Response to a Chronic Pain Rehabilitation Program

Abstract: These results suggest that bariatric patients may be at risk for treatment non-adherence and have difficulty reducing medication use in the treatment of chronic pain.

Cited by 7 publications

References 35 publications

Increased intravenous morphine self-administration following Roux-en-Y gastric bypass in dietary obese rats

Increased intravenous morphine self-administration following Roux-en-Y gastric bypass in dietary obese rats

Chronic abdominal pain and persistent opioid use after bariatric surgery

Peri-operative pain in patients experiencing bariatric surgery

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