Chronic Opioid Use Higher Post-Surgery

After knee surgery, patients were 5 times more likely to use opioids chronically compared with nonsurgical patients.

A recent study found that patients undergoing common surgeries have an increased risk of becoming chronic opioid users.

However, researchers are not suggesting that patients forgo surgery, but instead advise surgeons and physicians to monitor patient opioid use, according to a study published in JAMA International Medicine.

“The message isn't that you shouldn't have surgery,” said study lead author Eric Sun, MD, PhD. “Rather, there are things that anesthesiologists can do to reduce the risk by finding other ways of controlling the pain and using replacements for opioids when possible.”

Researchers examined chronic opioid use after 11 types of surgeries. Chronic opioid use was defined as patients who filled 10 or more prescriptions, or who received more than a 120-day supply, according to the study.

They analyzed health claims data from 641,941 patients who underwent surgery and were privately insured. Researchers also included 18 million nonsurgical patients. No patients filled an opioid prescription 1 year prior to surgery.

They discovered that patients who underwent knee surgery were 5 times more likely to use opioids chronically compared with the nonsurgical control group. Furthermore, patients who underwent gall bladder surgery were 3.5 times more likely to use opioids chronically, according to the study.

“We also found an increased risk among women following cesarean section, which was somewhat concerning since it is a very common procedure,” Dr Sun said.

Other factors that increased the risk of opioid abuse included being male, elderly, taking antidepressants, or abusing drugs, according to the study.

“Even when taken exactly as prescribed, opioids carry significant risks and side effects,” said study co-author Beth Darnall, PhD. “Ideally, opioids are avoided in treating chronic pain, and pain treatment should emphasize comprehensive care, including physical therapy, pain psychology and self-management strategies.”

Researchers added that other pain management options should be used after surgery. Alternative pain management options such as diaphragmatic breathing, progressive muscle relaxation, and mindful meditation could be used to calm the nervous system, according to the study.

“It turns out that a lot of chronic pain develops from surgery, and pre-surgical pain 'catastrophizing' is a major risk factor for having a lot of pain,” Dr Darnall concluded. “We hope that by optimizing patients' psychology, and giving them skills to calm their own nervous system, they will have less pain after surgery, need fewer opioids and recover quicker.”