Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic

Abstract

Physicians, policymakers, and researchers are increasingly focused on finding ways to decrease opioid use and overdose in the United States both of which have sharply increased over the past decade. While many efforts are focused on the management of chronic pain, the use of opioids in surgical patients presents a particularly challenging problem requiring clinicians to balance two competing interests: managing acute pain in the immediate postoperative period and minimizing the risks of persistent opioid use following the surgery. Finding ways to minimize this risk is particularly salient in light of a growing literature suggesting that post-surgical patients are at increased risk for chronic opioid use. The perioperative care team, including surgeons and anesthesiologists, is poised to develop clinical and systems-based interventions aimed at providing pain relief in the immediate postoperative period while also reducing the risks of opioid use longer term. In this paper, we discuss the consequences of chronic opioid use following surgery, and present an analysis of the extent to which surgery has been associated with chronic opioid use. We follow with a discussion of the risk factors that are associated with chronic opioid use after surgery, and proceed with an analysis of the extent to which opioid sparing perioperative interventions (e.g., nerve blockade) have been shown to reduce the risk of chronic opioid use following surgery. We then conclude with a discussion of future research directions.

Pain Management with Early Regional Anesthesia in Geriatric Hip Fracture Patients

“…Additionally, because of the opioid epidemic, there may have been a Hawthorne effect of training and education on delirium and opioids, and the inpatient prescribing patterns of physicians may have changed over time. There has been a nationwide trend to decrease opioid prescribing 43 ; however, we have found no study in the literature that demonstrates that there has been a decrease use in inpatient opioid prescribing for acute pain related to hip fractures. This may be a sequala of the opioid epidemic, but it has not been shown in the literature.…”

In‐hospital opioid consumption, but not pain intensity scores, predicts 6‐month levels of pain catastrophizing following hepatic resection: A trajectory analysis

“…Interestingly, opioid consumption trajectories predicted 6-month pain catastrophizing, suggesting an association between opioid consumption and psychological responses. As stated previously, in-hospital opioid consumption is multifactorial (Hah, Bateman, Ratliff, Curtin, & Sun, 2017;Ip, Abrishami, Peng, Wong, & Chung, 2009); such as being influenced by depression, anxiety, catastrophizing, physiological response to opioids. Results from the current study do not allow us to determine causal mechanisms.…”

Current Status and Future Directions of Pain-Related Outcome Measures for Post-Surgical Pain Trials

“…More recently, the largely North American opioid crisis has focused more attention on the amount of opioid use before and after surgery. 57 Although preoperative opioid use and preoperative painat or remote from the surgical sitehave been shown to be associated with a higher risk of persistent postoperative pain, 58 some large cohort studies have reported varying, but concerning, rates of chronic postoperative opioid use after minor surgery in previously opioid-na ïve patients. 57,59 As this research continues, it has been recognized that efforts to reduce opioid use, particularly after hospital discharge, requires further attention 60 and, thus, opioid consumption beyond the early postoperative period is an increasingly important trial outcome measure.…”