Most patients need little or no opioid pain medication after a postsurgical discharge, according to new research.
A study published in JAMA Network Open describes an ultrarestrictive approach to opioid prescriptions for postsurgical patients intended to curb the overall number of pills dispensed. Under the protocol, patients received no more than a three-day supply of opioid pain medication. In the case of ambulatory or minimally invasive surgeries, patients only received that limited prescription for opioids if they required more than five doses during the 24 hours before they got discharged.
At the same time, postoperative pain scores, complications and refill requests remained at similar levels before and after the protocol.
Doctors have undertaken a variety of efforts recently to reduce the number of opioid pain medications they prescribe. Overprescribing opioid pain medications leads to more diversion of pills, making them easier for existing addicts to get their hands on. It also puts a certain portion of the population at risk for developing an opioid addiction, says Emese Zsiros, M.D., Ph.D., who works at the Roswell Park Comprehensive Cancer Center in Buffalo, New York, and served as lead author on the study.
Zsiros points to resistance among patients and surgeons as the main factors that have kept more restrictive prescribing practices at bay. She says surgeons don’t seem generally aware of the extent to which short-term opioid courses can convert patients to chronic users.
Inertia has been a bigger issue, however. Surgeons don’t want patients to complain, and teaching hospitals don’t offer any formalized training for surgical residents about safe prescribing practices.
“When I was a resident, my senior resident would tell me what to prescribe, and that was the prescription that I copied for the next four years: 30-40 opioid tablets for every C-section patient and vaginal delivery patient, because I was told that this is when patients don’t complain,” Zsiros told FierceHealthcare.
To reduce patient resistance to the change, the protocol included brief patient education sessions to manage their expectations. Zsiros describes the sessions as fairly simple, letting patients know what medications they would get, and that most patients recover without issues on those medications.
“We also told them that feeling some pain after surgery is completely normal and acceptable, and our goal is to achieve optimal pain management so they can still be active but not have the side effects of taking the opioids,” she says.
Managing patient complaints brought even resistant doctors on board eventually as well. With no increase in patient complaints and stable pain scores, the practice became comfortable with the new protocol.
Despite the relatively small size of the study, Zsiros believes the results should be widely replicable.
“We have a particularly vulnerable patient population to begin with compared to many other surgical fields who operate on healthy patients and do elective cases,” she says. “If we could execute this protocol safely and prove that it was working in our patient population, I believe it’s equally applicable to the majority of the surgical field as well.”