PAIN
July 28, 2016

Surgery and the Risk of Opioid Addiction

Post-op patients on painkillers can run the risk of addiction. Who's vulnerable and how to avoid problems.

Everyone worries about pain as they head into surgery. They might also fear the risk of becoming addicted to the painkillers that they may be prescribed, according to a new study.

The risk of chronic opioid use — addiction — is small, so it should never be a reason to avoid surgery. But the findings of the Stanford study suggest that with abuse of prescription painkillers skyrocketing, it should be a reminder to physicians and surgeons to monitor patients’ opioid use, and use alternate methods of pain control if possible, Eric Sun, lead author of the study, told TheDoctor.

Many surgical procedures are associated with an increased risk of chronic opioid use in the postoperative period, even among people who have never used the drugs before. Certain patients, (men, elderly patients) may be particularly vulnerable, the study found.

Even when taken appropriately, opioids carry risks and can cause side effects.

Researchers examined health insurance claims of nearly 650,000 adult surgical patients undergoing 11 common surgical procedures — from gall bladder removal, hip and knee replacements, appendectomies, cesarean deliveries, sinus surgeries, prostate surgery and mastectomies.

Even when taken appropriately, opioids carry risks and can cause side effects.

They looked at the pharmacy records of nearly 170,000 surgical patients who were ‘ opioid-naïve,’ meaning they had not filled prescriptions for opioids in the 12 months prior to their surgery date, and compared them to the records from a nonsurgical control group who were randomly assigned a “surgery date” for the purposes of the study.

The incidence of chronic opioid use among the control group was 0.136 percent. Most surgical procedures except cataract surgery, sinus surgery and laproscopic appendectomy increased the risk of chronic opioid significantly. This risk ranged from .510 percent among surgical patients undergoing knee replacement to .128 percent risk among women who had a cesarean delivery. The increase in chronic opioid use following a cesarean delivery is of particular concern because it is such a common procedure, Sun said.

The study found that if a patient was male and over 50 years old, or had used tranquillizers, antipsychotics, antidepressants, and a history of drug or alcohol abuse, psychosis and depression, the risk of chronic opioid use rose.

Even when taken appropriately, opioids carry risks and can cause side effects. “Ideally, opioids are avoided in treating chronic pain, and pain treatment should emphasize comprehensive care, including physical therapy, pain psychology and self management strategies,” Beth Darnell, a co-author of the study, said. She and Sun and their colleagues in Stanford’s anesthesiology department give regional anesthetics when possible and encourage patients to use other medications, such as acetaminophen and ibuprofen, for pain control.

“Patients should be aware of how much pain medication they are taking and discuss this with their doctor or surgeon,” Sun warns. It's hard to resist a pill that makes pain go away, but given the risks, avoiding opioids if at all possible is likely the safest — if not the most pain-free — course of action.

The study is published online in JAMA Internal Medicine.

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