A Systematic Review of the Relative Frequency and Risk Factors for Prolonged Opioid Prescription Following Surgery and Trauma Among Adults

Pagé, M. Gabrielle; Kudrina, Irina; Zomahoun, Hervé Tchala Vignon; Croteau, Jordie; Ziegler, Daniela; Ngangue, Patrice; Martin, Élisabeth; Fortier, Maude; Boisvert, Esthelle Ewusi; Beaulieu, Pierre; Charbonneau, Céline; Cogan, Jennifer; Daoust, Raoul; Martel, Marc O.; Neron, André; Richebé, Philippe; Clarke, Hance

doi:10.1097/sla.0000000000003403

Cited by 64 publications

(71 citation statements)

References 69 publications

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“…e rate of poorly controlled postoperative pain in this cohort of patients is comparable to that seen in previous studies [59]. Furthermore, many of these other surgical procedures are associated with the risk of chronic opioid therapy [60,61]. Integrating this service into surgical specialities would allow immediate feedback of poor pain control to healthcare professionals around the clock, and ensuring a response to poor pain control via the device at any time may further empower patients, leading to improved trust.…”

Section: Limitationssupporting

confidence: 81%

An Interactive Pain Application (MServ) Improves Postoperative Pain Management

Gordon-Williams

Trigo

Bassett

et al. 2021

Pain Research and Management

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Background. Most patients have moderate or severe pain after surgery. Opioids are the cornerstone of treating severe pain after surgery but cause problems when continued long after discharge. We investigated the efficacy of multifunction pain management software (MServ) in improving postoperative pain control and reducing opioid prescription at discharge. Methods. We recruited 234 patients to a prospective cohort study into sequential groups in a nonrandomised manner, one day after major thoracic or urological surgery. Group 1 received standard care (SC, n = 102), group 2 were given a multifunctional device that fed back to the nursing staff alone (DN, n = 66), and group 3 were given the same device that fed back to both the nursing staff and the acute pain team (DNPT, n = 66). Patient-reported pain scores at 24 and 48 hours and patient-reported time in severe pain, medications, and satisfaction were recorded on trial discharge. Findings. Odds of having poor pain control (>1 on 0–4 pain scale) were calculated between standard care (SC) and device groups (DN and DNPT). Patients with a device were significantly less likely to have poor pain control at 24 hours (OR 0.45, 95% CI 0.25, 0.81) and to report time in severe pain at 48 hours (OR 0.62, 95% CI 0.47–0.80). Patients with a device were three times less likely to be prescribed strong opioids on discharge (OR 0.35, 95% CI 0.13 to 0.95). Interpretation. Using an mHealth device designed for pain management, rather than standard care, reduced the incidence of poor pain control in the postoperative period and reduced opioid prescription on discharge from hospital.

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Section: Limitationssupporting

confidence: 81%

An Interactive Pain Application (MServ) Improves Postoperative Pain Management

Gordon-Williams

Trigo

Bassett

et al. 2021

Pain Research and Management

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“…11 Considering the pain induced by traumatic injuries and acute surgical procedures, opioids are frequently prescribed in these contexts. 12 13 However, chronic opioid use (therapy >3 months), 14 has been documented in more than half of trauma and surgical patients 15 and may be used up to 5 years after the initial prescription. 16 The chronic use of opioids is associated with a 30% incidence of opioid use disorder, 17 described as a problematic pattern of opioid consumption leading to clinically significant impairment and distress.…”

Section: Introductionmentioning

confidence: 99%

Strategies aimed at preventing chronic opioid use in trauma and acute care surgery: a scoping review protocol

et al. 2020

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IntroductionGlobally every year, millions of patients sustain traumatic injuries and require acute care surgeries. A high incidence of chronic opioid use (up to 58%) has been documented in these populations with significant negative individual and societal impacts. Despite the importance of this public health issue, optimal strategies to limit the chronic use of opioids after trauma and acute care surgery are not clear. We aim to identify existing strategies to prevent chronic opioid use in these populations.Methods and analysisWe will perform a scoping review of peer-reviewed and non-peer-reviewed literature to identify studies, reviews, recommendations and guidelines on strategies aimed at preventing chronic opioid use in patients after trauma and acute care surgery. We will search MEDLINE, EMBASE, PsycINFO, CINHAL, Cochrane Central Register of Controlled Trials, Web of Science, ProQuest and websites of trauma and acute care surgery, pain, government and professional organisations. Databases will be searched for papers published from 1 January 2005 to a maximum of 6 months before submission of the final manuscript. Two reviewers will independently evaluate studies for eligibility and extract data from included studies using a standardised data abstraction form. Preventive strategies will be classified according to their types and targeted trauma populations and acute care surgery procedures.Ethics and disseminationResearch ethics approval is not required as this study is based on the secondary use of published data. This work will inform research and clinical stakeholders on the required next steps towards the uptake of effective strategies aimed at preventing chronic opioid use in trauma and acute care surgery patients.

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“…A related issue has been the question of persistent postoperative opioid use. A plethora of recent investigations and reviews have tallied prescriptions or filled pharmacy claims, 3,4 characterized as "persistent postoperative opioid use," and promoted it as having contributed to the opioid crisis. Nevertheless, there is no accepted definition of "persistent postoperative opioid use," and myriad different definitions abound.…”

mentioning

confidence: 99%

“…4 So too is the wide variability in reported estimates of persistent postoperative opioid use among opioid-naive patients, ranging from 0.01 to 14.7%, 5 0.6 to 26%, 4 and 0.1 to 45% of patients. 3 The power of the investigation by Jivraj et al is in the application of the 29 definitions to the same patient population, demonstrating that much if not most of the diversity in published estimates of "persistent postoperative opioid use" apparently derives more from the arbitrary and divergent definitions, rather than differences in populations or actual use. This is methodologic trouble.…”

mentioning

confidence: 99%

“…The definitional problem and variability in reported estimates of persistent postoperative opioid use [3][4][5] are even more problematic because studies do not inform at all on why the opioids were used, even if assuming that they were used. Reports on "persistent postoperative opioid use" do not identify whether they are taken for surgical pain, preexisting pain, new nonsurgical pain, sleep, or other reasons, or are stored, disposed, or diverted.…”

mentioning

confidence: 99%

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