Bariatric surgery may help obese patients lose weight, but it is far less effective in getting them to stop using opioid pain medicines, according to a new study published in the Journal of the American Medical Association.
Kaiser Permanente researchers examined a database of nearly 12,000 obese patients who underwent bariatric surgery between 2005 and 2009.
In the year prior to their surgery, 56% of the obese patients reported no opioid use, 36% used some opioids, and 8% used opioids on a chronic basis. Chronic opioid use was defined as having 10 or more prescriptions over at least 90 days or a 120-day total supply of pain medication.
A year after their surgery, not only were 77% of the chronic opioid users still taking prescription pain medication, but the amount of opioids they were using increased by 13%.
The results were a bit of a surprise to researchers, who expected opioid use to decline after surgery, not go up. Weight loss can lower pain levels from diseases such as osteoarthritis.
“We anticipated [that] weight loss after bariatric surgery would result in reduced pain and opioid use among patients with chronic pain. However, patients with and without preoperative chronic pain, depression diagnoses, or both had similar increases in postoperative chronic opioid use after surgery,” said lead study author Marsha A. Raebel, PharmD, a senior investigator at Kaiser Permanente’s Institute for Health Research.
Raebel says the increased use of opioids may be due to the limited options for pain management available to bariatric surgery patients, who are warned not to take non-steroidal, anti-inflammatory medications (NSAIDs) because they could raise their risk of getting ulcers.
“Obese patients are often more sensitive to pain and tend to be prescribed increasing opioid doses in order to manage that pain,” said Raebel. “Given the increasing chronic usage rate reported in this study, it’s clear that the medical community needs to develop better pain management programs for patients who use opioids long-term following bariatric surgery.”
More than 200,000 bariatric surgeries were performed in the U.S. in 2012. Typically weight loss is achieved by reducing the size of the stomach with a gastric band or through the removal of a portion of the stomach.
In an accompanying editorial also published in JAMA, Daniel Alford, MD, of Boston Medical Center, said the findings indicate a need for health care providers to do a better job helping patients reduce or stop their use of opioids.
“Knowing when and how to continue, change, or discontinue opioid therapy must be included in all clinician education efforts. Although Raebel et al are correct in reporting that better pain management strategies are needed, they also may have uncovered an equally important problem — the need to know if, when, and how to safely and effectively taper or discontinue opioid therapy for patients with chronic pain,” Alford wrote.