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Stanford University School of Medicine

Stanford study: Battle the opioid epidemic one surgery at a time

Blue pillowsSurgery can lead to increased risks of chronic opioid abuse, according to a study published today in JAMA Internal Medicine. But this increased risk is slight, and it certainly doesn’t mean you should shy away from surgery because of fears of opioid addiction, according the researchers.

From the study:

...It’s a reminder that surgeons and physicians should closely monitor patients’ use of painkillers — even for those patients who don’t have a history of using opioids — after surgery, and use alternate methods of pain control whenever possible.

The research stemmed from a desire of Eric Sun, MD, PhD, an anesthesiologist at Stanford who routinely administers drugs to surgery patients, to know more about the role surgery plays in the current opioid epidemic. Seventy-eight Americans die daily from an opioid overdose, according to the Centers for Disease Control and Prevention, and as someone who delivers anesthesia regularly to surgery patients, the problem strikes close to home for Sun. "Even though anesthesiologists don’t follow-up with patients, there are things we can do to reduce the risk of opioid abuse," he told me.

Previous studies have shown that surgery increases the risk of chronic opioid use, Sun said, but no studies looked at only patients who had no prior use of opioids. That’s what he and colleagues set out to do: "We wanted to know if there was this same risk for people who aren’t using opioids when they come in for surgery. Are they at higher risk for using opioids longer term?"

The researchers looked at opioid prescriptions filled by patients following 11 of the most common surgeries, including knee, prostate, and gall bladder procedures, by acquiring health claims from Marketscan, a database of 35 million beneficiaries. As I describe in our press release:

The researchers examined health claims from from 641,941 privately-insured patients who had not filled an opioid prescription in the year prior to surgery, then compared them to about 18 million nonsurgical patients, also free of opioid use for at least a year. ... Among the prescriptions drugs examined in the study were opioids such as hydrocodone, oxycodone and fentanyl — the drug responsible for the recent accidental overdose death of legendary performer Prince.

Results showed that the more painful the surgeries, the higher the likelihood of chronic opioid use after surgery:

"For a lot of surgeries there is a significantly higher chance of getting hooked on pain killers," Sun said. "The largest risk was for knee surgery and gall bladder surgery, not surprisingly, because they are considered the more painful.

We also found an increased risk post-cesarean section that was somewhat concerning since it is a very common procedure."

The overall low risk of just 0.5 percent indicates that the benefits of surgery far outrank the risks of drug addiction, the researchers said. Instead of foregoing surgery, physicians and patients need to emphasize other pain relief methods.

In addition to regional anesthetics during surgery and pain relief medications such as Tylenol post surgery, these methods can include physical therapy, pain psychology and self-management strategies, the study states. Beth Darnell, PhD, a co-author of the study and author of the book: Less Pain, Fewer Pills discussed some of the behavioral treatment methods she also studies.

"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," Darnell told me. "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."

Previously: A real medical problem: a Stanford physician reflects on treating patients with opioid addictions, New money for opioid abuse welcomed to help uninsured, says Stanford’s Keith HumphreysOpioid abuse among seniors: Stanford pain expert testifies on issue before U.S. Senate and Is a push to treat chronic pain pressuring doctors to prescribe opioids to addicts?
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