A study published in the Annals of Surgery could help clinicians mitigate that risk by identifying which patients are more likely to continue to use opioids after their immediate recovery period.
“There is not much research on which surgical patients require more or less opioids, despite a push in the field for personalised medicine,” said Daniel Larach, MD, then with the University of Michigan, Ann Arbor, Michigan, now at the University of Southern California, Los Angeles, California. “Often with postoperative opioid prescribing, personalisation falls by the wayside, with surgeons using the same amounts for every person receiving a certain procedure.”
The researchers looked at data for more than 1,000 people undergoing an elective hysterectomy, thoracic surgery, or a total knee or hip replacement. Before their procedures, each patient provided demographic information and filled out several screening questionnaires. They were given scores measuring their degree of depression, anxiety, fatigue, sleep disturbance, physical function, as well as the severity of their overall and surgical site pain. The research team also measured how many tablets were prescribed per patient. Each patient was then contacted one month following surgery to assess how many opioid tablets they had consumed.
“We found that anxiety is linked with more opioid use, which is disheartening to see but also heartening in the sense that this is something we could potentially target,” said Dr. Larach.
Other patient factors linked to increased opioid use included younger age, non-white race, no college degree, alcohol and tobacco use, and sleep disturbance.
Chad Brummett, MD, University of Michigan, said people may be knowingly or unknowingly medicating for other conditions.
“The only thing we’re giving them is opioids and we’re not giving them alternatives or other options,” he said.
For example, patients with high anxiety around the time of surgery could be offered behavioural care or other non-opioid medications for anxiety and resulting pain.
Dr. Brummett also noted that this study found overprescription of opioids for all surgical procedures and a correlation between the prescription size and use.
“I think it is striking that you see once again that the more you prescribe, the more patients take, even after adjusting for all of these other risk factors,” he said.
The researchers noted that right-sizing prescriptions through initiatives such as the Michigan Opioid Prescribing Engagement Network (OPEN), which provides recommendations for prescription amounts for various medical procedures, is a critical first step. But, they said, this step should be followed by more research into specific patient factors that can be addressed in other ways.
“We are asking surgeons to learn about and think about pain and behavioural health in ways that we have not previously done,” said Dr. Brummett. “It will require an open mind.”