Complete opioid cessation after surgery improves patient-reported pain measures among chronic opioid users

Holeman, Teryn A.; Buys, Michael J.; Bayless, Kimberlee; Anderson, Zachary; Hales, Julie B.; Brooke, Benjamin S.

doi:10.1016/j.surg.2022.04.034

Cited by 5 publications

(2 citation statements)

References 18 publications

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“…Chronic opioid use prior to TKA may lead to physical dependence, a state of adaptation that produces symptoms of withdrawal when the drug is abruptly stopped or dose rapidly reduced [30]. A recent study evaluated the effectiveness of a transitional pain service intervention aimed at completely tapering chronic opioid users off opioids by 60 days after elective surgery [32]. Impressively, 70% of chronic opioid users who underwent orthopedic surgery completely tapered off opioids within 60 days after discharge from the hospital and experienced significant improvements in pain intensity and interference compared to patients who did not completely cease opioids.…”

Section: Discussionmentioning

confidence: 99%

A modern multimodal pain protocol eliminates the need for opioids for most patients following total knee arthroplasty: results from a retrospective comparative cohort study

et al. 2023

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Purpose Modern multimodal analgesia has been shown to significantly reduce opioid use following total knee arthroplasty (TKA). This study was conducted to determine if changing TKA discharge opioid prescriptions from automatic to upon request resulted in more opioid free recoveries without compromising pain control. Methods Between December 2019 and August 2021, an orthopedic surgeon performed 144 primary unilateral TKAs; patients received the same multimodal analgesia protocol except for postoperative opioid prescribing. The first consecutively-treated cohort automatically received an opioid prescription following discharge (automatic group) and the second cohort received opioid prescriptions only upon request (upon request group). Opioid prescription data were derived from a prescription monitoring program and patient-reported outcomes (PROs) were collected preoperatively and at 2 and 12 weeks postoperatively. Results A higher percentage of the upon request group was opioid free 3 months after TKA compared with the automatic group (55.6% vs 4.3%, p < 0.0001) without compromising pain or function. Among opioid-naïve patients, 72% in the upon request group were opioid free after TKA compared with 5.4% in the automatic group. Opioid prescribing was not significantly reduced among opioid-experienced patients regardless of the pain protocol. Conclusion Requiring patients to request opioid prescriptions following TKA resulted in a higher rate of opioid free TKA, especially among opioid-naïve patients, without increasing pain compared with offering all patients an initial opioid prescription. Level of evidence Level III.

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Section: Discussionmentioning

confidence: 99%

A modern multimodal pain protocol eliminates the need for opioids for most patients following total knee arthroplasty: results from a retrospective comparative cohort study

et al. 2023

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“…The Johns Hopkins Personalized Pain Program (PPP) is a transitional perioperative pain service offering specialized pain management and concurrent psychiatric treatment for patients with preoperative pain and opioid use or those at risk of long-term opioid therapy [26]. Consistent with findings from other institutions [30][31][32][33], the PPP has shown success in facilitating reductions of postoperative opioid consumption with concurrent improvements in clinical outcomes [34][35][36]. Collectively, these data evidence that long-term, multidisciplinary, coordinated pain management adds healthcare value for surgical patients at greatest risk of chronic pain and high-dose long-term opioid use.…”

Section: Introductionmentioning

confidence: 89%

Patient Experiences and Clinical Outcomes in a Multidisciplinary Perioperative Transitional Pain Service

Manoharan,

Xie,

Hsu

et al. 2023

JPM

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Siloed pain management across the perioperative period increases the risk of chronic opioid use and impedes postoperative recovery. Transitional perioperative pain services (TPSs) are innovative care models that coordinate multidisciplinary perioperative pain management to mitigate risks of chronic postoperative pain and opioid use. The objective of this study was to examine patients’ experiences with and quality of recovery after participation in a TPS. Qualitative interviews were conducted with 26 patients from The Johns Hopkins Personalized Pain Program (PPP) an average of 33 months after their first PPP visit. A qualitative content analysis of the interview data showed that participants (1) valued pain expectation setting, individualized care, a trusting patient–physician relationship, and shared decision-making; (2) perceived psychiatric treatment of co-occurring depression, anxiety, and maladaptive behaviors as critical to recovery; and (3) successfully sustained opioid tapers and experienced improved functioning after PPP discharge. Areas for improved patient-centered care included increased patient education, specifically about the program, continuity of care with pain specialists while tapering opioids, and addressing the health determinants that impede access to pain care. The positive patient experiences and sustained clinical benefits for high-risk complex surgical patient support further efforts to implement and adapt similar models of perioperative pain care.

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A retrospective analysis of perioperative medications for opioid‐use disorder and tapering additional postsurgical opioids via a transitional pain service

Liu,

Leon,

Gough

et al. 2024

Brit J Clinical Pharma

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AimsTo investigate perioperative opioid requirements in patients on methadone or buprenorphine as medication for opioid‐use disorder (MOUD) who attended a transitional pain clinic (Personalized Pain Program, PPP).MethodsThis retrospective cohort study assessed adults on MOUD with surgery and attendance at the Johns Hopkins PPP between 2017 and 2022. Daily non‐MOUD opioid use over 6 time‐points was evaluated with regression models controlling for days since surgery. The time to complete non‐MOUD opioid taper was analysed by accelerated failure time and Kaplan–Meier models.ResultsFifty patients (28 on methadone, 22 on buprenorphine) were included with a median age of 44.3 years, 54% male, 62% Caucasian and 54% unemployed. MOUD inpatient administration occurred in 92.8% of patients on preoperative methadone but only in 36.3% of patients on preoperative buprenorphine. Non‐MOUD opioid use decreased over time postoperatively (β = −0.54, P < .001) with a median decrease of 90 mg morphine equivalents (MME) between the first and last PPP visit, resulting in 46% tapered off by PPP completion. Older age and duration in PPP were associated with lower MME, while mental health conditions, longer hospital stays and higher discharge opioid prescriptions were associated with higher MME. The average time to non‐MOUD opioid taper was 1.79× longer in patients on buprenorphine (P = .026), 2.75× in males (P = .023), 4.66× with mental health conditions (P < .001), 2.37× with chronic pain (P = .031) and 3.51× if on preoperative non‐MOUD opioids; however, higher initial MOUD level decreased time to taper (P = .001).ConclusionsPostoperative opioid tapering utilizing a transitional pain service is possible in patients on MOUD.

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Complete opioid cessation after surgery improves patient-reported pain measures among chronic opioid users

Cited by 5 publications

References 18 publications

A modern multimodal pain protocol eliminates the need for opioids for most patients following total knee arthroplasty: results from a retrospective comparative cohort study

A modern multimodal pain protocol eliminates the need for opioids for most patients following total knee arthroplasty: results from a retrospective comparative cohort study

Patient Experiences and Clinical Outcomes in a Multidisciplinary Perioperative Transitional Pain Service

A retrospective analysis of perioperative medications for opioid‐use disorder and tapering additional postsurgical opioids via a transitional pain service

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