Certain prescribing patterns, surgical procedures, and patient characteristics increase patients’ risk of long-term opioid use following surgery or trauma, according to a study published in the Journal of Bone and Joint Surgery.
“Approximately 4% of the general population will use prescribed opioids for an extended time after surgery, but, among patients with a history of prescription opioid use, nearly a quarter of patients will continue to use prescribed opioids for an extended time period after surgery,” said Ara Nazarian, PhD, Harvard Medical School, Boston, Massachusetts. “Understanding the pooled effect of risk factors can help physicians develop effective and individualised pain management strategies with a lower risk of prolonged opioid use.”
For the study, the researchers analysed findings from 37 studies with nearly 2 million participants. The overall rate of prolonged opioid use among participants was <5%. By pooling the data, they demonstrated that prior use of prescribed opioids or benzodiazepines (odds ratio [OR] = 11.04; 95% confidence interval [CI], 9.39-12.97), history of back pain (OR = 2.10; 95% CI, 2.00-2.20), and depression (OR = 1.62; 95% CI, 1.49-1.77) were among the most important patient-related factors predicting which patients would continue to use prescription opioids beyond 2 months.
While depression and chronic pain were significant risk factors, the use of antidepressants or non-narcotic painkillers did not appear to increase the patients’ prolonged use of opioids.
“Depression is also highly correlated with chronic postsurgical pain,” said Amin Mohamadi, MD, Beth Israel Deaconess Medical Center, Boston, Massachusetts. “Our findings suggest that addressing concurrent mental health problems and managing postsurgical pain using multiple modalities including non-narcotic analgesics could mitigate the risk of prolonged use of opioids associated with depression or pain.”
The researchers also noted that physician prescribing practices can influence the incidence of prolonged opioid use, as long-term opioid use is significantly higher among patients treated by high-intensity prescribers than among those treated by low-intensity prescribers.
Physicians tend to prescribe opioids to women more often than men, and may avoid the use of non-steroidal anti-inflammatory drugs in patients with cardiovascular concerns, opting for opioid analgesics instead. These prescribing practices may explain why gender and cardiovascular health are significant risk factors for prolonged opioid use.
“On the other hand, physician behaviour may also mitigate the occurrence of prescribed opioid dependence,” concluded Dr. Mohamadi. “Providing patients with adequate pain relief, involving patients in pain management planning with realistic goal-setting, providing [patients] with comprehensible information about the risks of opioid use, tapering opioid use prior to hospital discharge, and using more uniform prescribing protocols could reduce the overall burden of long-term opioid use following surgery or trauma.”