Low risk of developing chronic opioid use following surgery, but transitional pain service needed

Written by Peter Brown

Researchers at Toronto Western Hospital (ON, Canada) have measured rates of opioid use in patients up to a year after receiving major surgery. Opioids are routinely used after major surgery to treat postoperative pain; however, there are limited data concerning individuals developing persistent opioid use. This new study indicates that the risk of chronic opioid use in opioid-inaive patients is low; however, better risk identification and long-term support is needed.
A team from Toronto Western Hospital (ON, USA) has demonstrated that patients who have not had an opioid prescription within a year prior to a major elective surgical procedure are at low risk of developing persistent opioid use, having followed 39,140 patients after surgery and observed for opioid use.

In the cohort study, published in JAMA Surgery, anonymized administrative population-based health care data were retrospectively analyzed to assess opioid use following surgery, as opioid exposure can potentially risk addiction.

The Institute for Clinical Evaluative Sciences (ICES) provided a database for outpatient prescriptions dispensed to Ontario residents aged 65 years or older. The study group comprised individuals aged over 66 years who were opioid-naive and received major elective surgeries between 2003 and 2010. The time to opioid cessation was measured for individuals receiving opioid prescriptions within 90 days of surgery, defining the date of cessation by the absence of any opioid prescription within the preceding 90 days.

Of the 39,140 opioid-naive patients identified, 53% were prescribed opioids within 90 days of their discharge. One year post-surgery, 168 of 37,650 surviving patients (0.4%) continued receiving opioid prescriptions, suggesting a relatively low risk of developing persistent opioid use after receiving major surgery.

Dr Neilesh Soneji, Staff Anesthesiologist, Toronto Western Hospital and the lead author of the study, concluded that the findings “provide reassurance that the current strategies to manage acute pain after surgery are associated with a low risk of persistent opioid use in our study population.” However, they went on to add: “the large volume of surgeries performed annually means that the population burden of long-term postoperative opioid use remains significant.”

Although this study demonstrates a low risk of developing further use, research is still required in order to find alternative prescriptions and reduce further the risk of opioid dependence. The authors also highlight the need for a transitional pain service as a potential solution to this problem, following investigating the 3-month incidence of chronic post-surgical pain and long-term opioid use in patients at the Toronto General Hospital via a telephone survey of 200 patients as 3 months post-surgery. The results, published in Pain Management, found that 35% of patients reported having surgical site pain and 13.5% continued to use opioids for postsurgical pain relief, and the persistent use of opioids was linked with lower function and low mood.

Together, the two studies indicate that future research and interventions may be better aimed at assessing the higher-risk individuals and providing them with adequate resources, and that improved support in the modification of pain trajectories and opioid weaning following major surgery would be beneficial.

Sources: Huang A, Azam A, Segal S et al. Chronic postsurgical pain and persistent opioid use following surgery: the need for a transitional pain service. Pain Manag. doi:10.2217/pmt-2016-0004 (2016) (Epub ahead of print); Soneji N, Clarke HA, Ko DT, Wijeysundera DN. Risks of developing persistant opioid use after major surgery. JAMA Surgery doi:10.1001/jamasurg.2016.1681 (2016) (Epub ahead of print)

You can read an exclusive interview with Hance Clarke, author on both papers, here.