Defining optimal opioid pain medication prescription length following surgery

September 27, 2017, Brigham and Women's Hospital
Credit: CC0 Public Domain

A new study led by researchers at the Center for Surgery and Public Health at Brigham and Women's Hospital analyzed opioid prescription data from the Department of Defense Military Health System Data Repository, identifying more than 200,000 opioid-naïve individuals who had undergone one of eight common surgical procedures between 2006 and 2014 and were subsequently prescribed opioid pain medication. Their findings appear in JAMA Surgery as a featured article for the week of Sept. 27.

Every day, more than 90 Americans die after overdosing on opioids, according to the National Institute on Drug Abuse. Misuse of and addiction to opioids has become a public health crisis with more than 2 million Americans suffering from substance abuse issues related to prescription opioid pain medication. While over-prescription of pain medications has been implicated as a driver of this growing opioid epidemic, few guidelines exist on how to appropriately prescribe opioid pain medication following surgery with the goal of balancing pain with risk of addiction. There have been several recent governmental efforts to address the rise in opioid pain medication prescriptions, which quadrupled between 1999 and 2012. In Mass. and New York, legislation has limited initial prescription lengths to less than seven days and driven the development of drug monitoring programs.

To determine optimal opioid pain medical prescribing practices, particularly in the setting of postoperative, outpatient pain management, researchers from the CSPH at BWH investigated opioid pain medical prescription patterns following common surgical procedures. The team sought to identify the appropriateness of the prescription as indicated by the rate of prescription refills and to develop recommendations.

Using a nationally representative sample of people who were opiate naïve undergoing common procedures, researchers found that median prescription length for the first-time prescriptions was four to seven days, and that the number of people who required a refill of their opiate prescription varied from 11.3 percent to 39.3 percent depending on the type of procedure performed. The duration of the prescription also varied depending on the category of procedure, from nine days for general surgery procedures to 15 days for musculoskeletal procedures.

"While seven days may be more than adequate for many patients undergoing common general surgery and gynecological procedures, prescription length limits may need to be extended to 10 days, recognizing that as many as 40 percent of patients may still require a refill at a seven-day limit for pain management, particularly following many orthopedic and neurosurgical procedures," said first author Rebecca Scully, MD, MPH, a resident in the Department of Surgery at BWH who works in the CSPH.

Researchers used data from the Military Health System Data Repository, which tracks care delivered to active, disabled and retired members of the U.S armed forces and their dependents. Researchers identified 215,140 individuals aged 18-64 who had undergone one of eight common surgical procedures (cholecystectomy, appendectomy, inguinal hernia repair, ACL reconstruction, rotator cuff tear repair, discectomy, mastectomy and hysterectomy) between 2006 and 2014 and had filled at least one opioid pain medication prescription in the 14 days following the procedure. The study excluded individuals with a prior diagnosis of chronic pain, substance dependence or an opioid prescription within six months preceding the index procedure. General surgery procedures were performed on 122,435 individuals, while 47,998 underwent musculoskeletal procedures, and 44,707 received a mastectomy or hysterectomy.

Using a mathematical model, researchers determined that the optimal length of opiate prescription was four to nine days for general surgery procedures, four to 13 days for women's health procedures, and six to 15 days for musculoskeletal procedures.

"We recognize that the opiate crisis is being addressed on many social, legislative, and policy levels," said senior author Louis Nguyen, MD, MBA, MPH. "We hope our paper provides a quantitative analysis of current prescribing patterns and sheds light on the optimal prescription in patients undergoing surgical procedures."

Explore further: Study finds common surgeries may serve as pathway to nonmedical opioid use in adolescents

More information: JAMA Surgery (2017). DOI: 10.1001/jamasurg.2017.3132

Related Stories

Study finds common surgeries may serve as pathway to nonmedical opioid use in adolescents

September 15, 2017
Research being presented at the American Academy of Pediatrics 2017 National Conference and Exhibition shows that post-surgical opioid pain medications prescribed after common surgeries may become a pathway to continued, ...

Study examines initial events linked to sustained opioid use

August 16, 2017
Most of the events that led to sustained prescription opioid use were not hospital events and associated procedures, but diagnoses that were either nonspecific or associated with spinal or other conditions for which opioid ...

Twelve percent of women fill opioid rx after vaginal delivery

February 10, 2017
(HealthDay)—Twelve percent of women fill an outpatient opioid prescription within five days of vaginal delivery, according to a study published in the March issue of Obstetrics & Gynecology.

Medicaid patients continue high prescription opioid use after overdose

August 22, 2017
Despite receiving medical attention for an overdose, patients in Pennsylvania Medicaid continued to have persistently high prescription opioid use, with only slight increases in use of medication-assisted treatment, according ...

Study reveals high rates of opioid prescriptions and excessive dosing in dialysis patients

September 21, 2017
A new analysis indicates that the US opioid epidemic likely applies to the unique population of dialysis patients. The study, which appears in an upcoming issue of the Journal of the American Society of Nephrology (JASN), ...

Patients taking opioids prior to ACL surgery more likely to be on pain medications longer

July 22, 2017
More than 130,000 Anterior Cruciate Ligament (ACL) surgeries take place each year with the majority of patients not requiring pain medication after three months post-operatively. However, researchers presenting their work ...

Recommended for you

Cold open water plunge provides instant pain relief

February 12, 2018
A short, sharp, cold water swim may offer an alternative to strong painkillers and physiotherapy to relieve severe persistent pain after surgery, suggest doctors in the journal BMJ Case Reports.

Study spotlights risks in anesthesiologist handoffs

February 9, 2018
Most patients are totally unaware that the anesthesiologist who put them under for surgery might not be the same one who brings them out even though that 'handoff' between the two doctors has been linked to a series of negative ...

One in five older adults experience brain network weakening following knee replacement surgery

February 7, 2018
A new University of Florida study finds that 23 percent of adults age 60 and older who underwent a total knee replacement experienced a decline in activity in at least one region of the brain responsible for specific cognitive ...

New algorithm decodes spine oncology treatment

February 6, 2018
Every kind of cancer can spread to the spine, yet two physician-scientists who treat these patients describe a paucity of guidance for effectively providing care and minimizing pain.

Patients and doctors often disagree in evaluation of surgical scarring

February 1, 2018
When it comes to the physical scars surgery leaves behind, a new study shows patients and doctors often don't assess their severity the same way. Researchers from the Perelman School of Medicine at the University of Pennsylvania ...

Boosting a key protein to help bones that won't heal

February 1, 2018
When a patient breaks a bone, there's a possibility the fracture won't heal properly or quickly—even with the aid of pins, plates or a cast.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.