Authors: Dugan MQ et al.
BMJ Journal Regional Anesthesia & Pain Medicine
This multicenter prospective study evaluated whether preoperative substance use—identified using the validated Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) questionnaire—is associated with postoperative pain intensity.
Background
Substance use is common in surgical populations and has been associated with greater opioid prescribing and use. However, the relationship between substance use and patient-reported postoperative pain has been less well defined.
Study Design
• 4,410 adults undergoing common surgical procedures
• Three institutions
• December 2018–July 2023
• Preoperative TAPS completed before surgery
Positive TAPS screening defined as:
• Tobacco use ≥ monthly
• Heavy alcohol use ≥ monthly
• Any recreational drug use
• Any non-prescribed use of prescription medication
Primary Outcome
Worst overall pain (0–10 scale) measured at:
• Baseline (preoperative)
• 2 weeks post-op
• 1 month post-op
Mixed linear models adjusted for patient characteristics.
Key Findings
-
Prevalence
42.2% screened positive for unhealthy substance use in the 12 months prior to surgery.
-
Baseline pain
Positive TAPS group reported higher preoperative pain:
• 3.51 vs 3.15 (p < 0.001)
-
2 weeks postoperatively
No statistically significant difference in worst pain scores.
-
1 month postoperatively
Higher pain in positive TAPS group:
• 2.66 vs 2.41 (p = 0.036)
Interpretation
Although statistically significant differences were observed at baseline and 1 month, the absolute pain score differences were small (≈0.25–0.36 points on a 0–10 scale), falling near or below typical minimal clinically important difference (MCID) thresholds.
This suggests:
• Substance use is common in surgical patients.
• It is associated with modestly higher self-reported pain.
• The magnitude of difference may be statistically robust but clinically small.
Possible Mechanisms
• Altered pain perception or central sensitization
• Coexisting mental health conditions
• Sleep disturbance
• Opioid tolerance or hyperalgesia in some subgroups
• Behavioral coping differences
Clinical Implications
Even if pain differences are modest, preoperative substance use screening may still be valuable because:
• Substance use predicts higher opioid consumption (shown in prior studies).
• It may signal vulnerability to prolonged recovery.
• The perioperative period is a potential intervention point.
The TAPS questionnaire is brief and feasible for routine clinical use, providing actionable information before surgery.
Key Points
• 42% of surgical patients reported unhealthy substance use.
• Positive TAPS screening correlated with slightly higher pain before surgery and at 1 month.
• No difference at 2 weeks post-op.
• Differences were statistically significant but small in magnitude.
• Preoperative screening may offer an opportunity for intervention.
For perioperative teams, this study reinforces that substance use is common and should be routinely assessed—not only for opioid stewardship but also to inform expectations around postoperative recovery.
This research supports integrating standardized screening tools into surgical workflows to identify at-risk patients and tailor perioperative care accordingly.
Thank you BMJ Journal Regional Anesthesia & Pain Medicine for allowing us to summarize this article.