Many patients who are prescribed opioids after surgery could get the same level of pain relief with non-opioid alternatives such as ibuprofen or acetaminophen without the risk of addiction, researchers say.
“Opioids have been a routine part of postsurgical pain care for decades, but the risk that they could lead to persistent use has been clearly documented,” said lead author Dr. Ryan Howard, a surgical resident at Michigan Medicine, the University of Michigan’s academic medical center in Ann Arbor.
“Perhaps it’s time to make them the exception, not the rule,” he noted in a university news release.
Howard and his colleagues analyzed data from more than 22,000 patients who had one of these common types of surgery — gynecological, hernia, gallbladder, appendix, bowel or thyroid.
Opioids were prescribed to 86% of the patients; 14% received prescriptions for non-opioid painkillers.
Within 30 days, 12% of patients in both groups had complications, emergency department visits or repeat surgery, the study found.
Patients who received non-opioids were slightly more likely to be readmitted to the hospital, but rarely due to pain-related issues, researchers found.
There was no difference between the two groups in the percentage of patients who sought emergency care for pain.
Nearly 6 out of 10 patients completed a survey about their pain in the week after leaving the hospital and other post-surgery issues.
Eighty-two percent of patients in both the opioid and non-opioid groups said they were satisfied with their care and 93% had no regrets about having surgery.
Patients in the non-opioid group were more likely to report being pain-free in the first week after surgery, however, than those in the opioid group (12% versus 7%).
They were also more likely to say they had the best possible quality of life after surgery (66% versus 63%), according to the findings, recently published in the journal Annals of Surgery.
“This study clearly shows no difference in pain, major adverse events or patient-centered outcomes when opioids aren’t prescribed,” said senior author Dr. Mark Bicket, a pain medicine specialist and co-director of the Michigan Opioid Prescribing Engagement Network (Michigan OPEN).
He said evidence about the risks of opioid medicines to the patient and to others who might misuse leftover pills from the patient’s prescriptions must be considered along with evidence about their relative effectiveness for pain control.
In a related study, Michigan OPEN researchers analyzed national insurance claims data on patients who weren’t taking opioids before surgery.
They found that between 4% and 7% of patients who had surgery requiring a hospital stay and 1.5% to 6.4% of patients who had outpatient surgery filled opioid prescriptions months after any surgical pain should have ended.
Patients with this new persistent opioid use had more hospital and emergency care in the year after surgery than those who didn’t fill a single opioid prescription immediately after their operation, according to the study led by Michigan OPEN co-director Dr. Chad Brummett.
In the June issue of the Journal of Managed Care and Specialty Pharmacy, Brummett’s team reported that patients who started taking opioids after surgery received five times more opioid prescriptions and had much higher overall health care costs than other patients.
The U.S. National Institute on Drug Abuse has more on prescription opioids.
SOURCE: Michigan Medicine-University of Michigan, news release, June 10, 2021