Pain and opioid prescriptions vary by procedure after breast surgery

Abstract

Background: With the opioid epidemic in the United States, evaluating opioid prescribing patterns is essential. We evaluated opioids prescribed at discharge following breast surgery and their association with patient factors and pain scores. Methods:We retrospectively identified adult patients who underwent a mastectomy for cancer at Mayo Clinic sites from January 2010 to December 2016. Pain scores and prescription data were compared across operations and patient factors by univariate and multivariable analyses.Results: Of 4021 patients, 3782 (94.1%) received an opioid prescription. Median oral milligram morphine equivalents (MME) were similar across all site-specific procedure groups (medians ranging from 225 to 375) while pain scores ranged from 1 to 4.Patients undergoing bilateral mastectomy (BM) and immediate breast reconstruction (IBR) reported the greatest pain scores. Pain scores did not vary with age or diagnosis for patients undergoing unilateral mastectomy or BM with lymph node surgery and IBR procedures.On multivariable analysis, variables associated with a MME discharge prescription >Q 4 values included age, body mass index, site, year, inpatient status, and pain before discharge >3.Conclusion: Patient-reported pain following breast surgery varied by procedure, while MMEs prescribed remained similar. This suggests current opioid prescribing does not reflect intensity of pain and requires further research to optimize discharge opioid prescribing practices.

Chronic Breast Pain Prior to Breast Cancer Surgery Is Associated with Worse Acute Postoperative Pain Outcomes

“…However, opioid doses were low and variability in opioid consumption was particularly high among women with preexisting breast pain compared to those without preexisting chronic pain (95% CIs of 5.1–9.3 vs 4.0–5.0), suggesting that while some patients had very little (if any) opioids postoperatively, others required relatively higher doses. Further, the postoperative opioid dosages overall (4.5 to 7.2 mg) were substantially lower than those reported in other similar samples (e.g., median 225–375 mg among > 4000 US patients) [ 26 ], and over half of the patients received no postoperative opioids at all, perhaps indicative of insufficient analgesia.…”

“…Analyses were conducted using SPSS Version 26 [ 26 ]. We calculated frequency distributions and descriptive statistics to describe the study sample.…”

Oral Analgesic Use in Postmenopausal Women After Curative Breast Cancer Treatment: Post Hoc Analysis of the ATAC Trial

“…Although concerns may exist about overuse of opioids in patients with cancer, a recent retrospective analysis of an administrative claims database showed that patterns of opioid utilization, including dosing and duration, were comparable for patients with cancer-and noncancer-related pain [13]. Previously published studies [14,15] in cancer patient populations utilized prescription datasets that provided information on the prescriptions filled, but little detail on the types of medications taken and their indications. Additionally, a systematic review by Wang et al [16] provided a comprehensive overview of reports of pain in published breast cancer studies but did not include insights into the treatments used for this pain.…”

“…Recent updates to pain-related treatment guidelines in cancer and noncancer pain [10][11][12] have highlighted the knowledge gap on the management of pain conditions in different patient populations, including the growing population of cancer survivors. Although the prevalence of different pain types has been described in cancer patients over time [4][5][6][7][8][9] and the types of prescription medications, including analgesics, that patients are taking have been evaluated based on prescription database analyses [13][14][15][16], there is a lack of data on the types of analgesics that cancer survivors are taking for the different types of pain they experience.…”

Doing Our Part to Mitigate the Opioid Crisis

“…As would be expected, Park et al 7 report that opioid consumption is correlated with the extent/invasiveness of the surgical procedure. While it may seem obvious that the amount of narcotic prescribed would be proportional to the extent of surgery performed, a retrospective study by Murphy et al 9 showed that in patients undergoing mastectomy, although patient-reported pain varied by procedure, prescribing practices did not reflect this difference.…”