By Ed Coghlan
Does having surgery increase a patient’s risk of becoming chronic users of opioid painkillers?
Stanford University School of Medicine researchers say that a study of health insurance claims showed that patients undergoing 11 of the most common types of surgery were at an increased risk of becoming chronic users of opioid painkillers.
The researchers don’t argue that people should put off surgery. Instead, they say, it’s a reminder that surgeons and physicians should closely monitor patients’ use of opioids after surgery — even patients with no history of using the pain-relieving drugs — and use alternate methods of pain control whenever possible.
The study was published July 11 in JAMA Internal Medicine.
“For a lot of surgeries there is a higher chance of getting hooked on painkillers,” said the study’s lead author, Eric Sun, MD, PhD, an instructor in anesthesiology at Stanford. Sean Mackey, MD/PhD, professor of anesthesiology, is the senior author of the study.
The researchers examined the risks of chronic opioid use following 11 common types of surgeries. Chronic opioid use was defined in the study as patients who filled 10 or more prescriptions or received more than a 120-day supply of an opioid in the first year following surgery, excluding the first three months after surgery.
Patients who had knee surgery had the largest risk, as they were roughly five times more likely than a control group of nonsurgical patients to end up using opioids chronically, followed by those undergoing gall bladder surgery, whose risk was three-and-a-half times greater than those in the control group.
“We also found an increased risk among women following cesarean section, which was somewhat concerning since it is a very common procedure,” adding that the risk was 28 percent higher than among the control group, Sun said.
Other factors that contributed to an increased risk for chronic opioid use included being male, elderly, taking antidepressants or abusing drugs.
Sun and colleagues set out to examine patients who hadn’t received prescriptions for opioids for at least one year prior to surgery. Among the opioid prescription drugs examined in the study were hydrocodone, oxycodone and fentanyl — the drug responsible for the recent accidental overdose death of legendary musician Prince.
Even when taken exactly as prescribed, opioids carry significant risks and side effects,” said study co-author Beth Darnall, PhD, clinical associate professor of anesthesiology and author of the book Less Pain, Fewer Pills: Avoid the Dangers of Prescription Opioids and Gain Control over Chronic Pain. “Ideally, opioids are avoided in treating chronic pain, and pain treatment should emphasize comprehensive care, including physical therapy, pain psychology and self-management strategies.”
As a pain psychologist and clinician-scientist, Darnall emphasizes alternate methods of pain management based on evidence-based techniques that can help calm the nervous system such as diaphragmatic breathing, progressive muscle relaxation and mindful meditation.