Persistent Postoperative Opioid Use

Kharasch, Evan D.; Clark, J. Kenji

doi:10.1097/aln.0000000000003298

Cited by 12 publications

(24 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…110 The problem of chronic postoperative pain affects up to 80% of patients, [113][114][115] and may lead to persistent postoperative opioid use. 102,[116][117][118] Postoperatively, "one-third of adults receiving long-term opioid therapy report that their first opioid prescription came from a surgeon, indicating that postsurgical prescribing is important…in the opioid epidemic," 119 and this is cited to suggest that opioids per se are the sole culprit. However, this ignores the fact that all chronic SPECIAL ARTICLE postoperative pain started as acute postoperative pain, and acute postoperative pain was the reason for this one third of patients to be prescribed opioids in the first place.…”

Section: Demand-side Opioid Managementmentioning

confidence: 99%

“…[129][130][131][132] It is imperative to find more successful methods and practices than currently available, and this unmet need should be a pressing research focus. 95,102,124,133 In the immediate, anesthesiologists should focus on carefully tailoring perioperative therapeutic regimens to the needs and circumstances of individual patients, and with the longest lasting benefit, preferably beyond just the immediate perioperative period and their time in hospital. If the prescribing of postoperative oral take-home opioids is to be right-sized, patients must feel confident that they will receive an adequate take-home supply to treat their pain and must receive the amount prescribed, and surgical prescribers must feel confident that they are providing enough to assure adequate analgesia and patient satisfaction, to minimize unwanted calls by patients for more, and to minimize the amount of unused leftover opioid pills.…”

Section: Demand-side Opioid Managementmentioning

confidence: 99%

“…Choose strategies that maximize pain control while minimizing the need for postoperative discharge oral opioids and associated potential long-term harm. 102 adequate analgesia, not withholding needed opioids, should be the primary goal. 133 Opioid-sparing by itself is not likely meaningful to patients unless accompanied by improved patient-centric outcomes like better pain relief or the sparing of undesirable opioid-related side effects.…”

Section: Evaluate Patient Preoperative Opioid Usementioning

confidence: 99%

“…3). 45,102 Since the publication of the Centers for Disease Control guidelines with strict thresholds for opioid prescribing, enthusiasm has waned for such supply-side management in some quarters. The American Medical Association (Chicago, Illinois), in its essay “8 keys to end the nation’s drug-overdose epidemic,” suggests eliminating ineffective opioid prescribing restrictions and shifting focus to the illicit opioid overdose epidemic.…”

Section: Managing the Size Of The Opioid Poolmentioning

confidence: 99%

“…129–132 It is imperative to find more successful methods and practices than currently available, and this unmet need should be a pressing research focus. 95,102,124,133…”

Section: Managing the Size Of The Opioid Poolmentioning

confidence: 99%

See 4 more Smart Citations

Opioids and Public Health: The Prescription Opioid Ecosystem and Need for Improved Management

2021

Self Cite

View full text Add to dashboard Cite

While U.S. opioid prescribing has decreased 38% in the past decade, opioid deaths have increased 300%. This opioid paradox is poorly recognized. Current approaches to opioid management are not working, and new approaches are needed. This article reviews the outcomes and shortcomings of recent U.S. opioid policies and strategies that focus primarily or exclusively on reducing or eliminating opioid prescribing. It introduces concepts of a prescription opioid ecosystem and opioid pool, and it discusses how the pool can be influenced by supply-side, demand-side, and opioid returns factors. It illuminates pressing policy needs for an opioid ecosystem that enables proper opioid stewardship, identifies associated responsibilities, and emphasizes the necessity of making opioid returns as easy and common as opioid prescribing, in order to minimize the size of the opioid pool available for potential diversion, misuse, overdose, and death. Approaches are applicable to opioid prescribing in general, and to opioid prescribing after surgery.

show abstract

Section: Demand-side Opioid Managementmentioning

confidence: 99%

Section: Demand-side Opioid Managementmentioning

confidence: 99%

Section: Evaluate Patient Preoperative Opioid Usementioning

confidence: 99%

Section: Managing the Size Of The Opioid Poolmentioning

confidence: 99%

“…129–132 It is imperative to find more successful methods and practices than currently available, and this unmet need should be a pressing research focus. 95,102,124,133…”

Section: Managing the Size Of The Opioid Poolmentioning

confidence: 99%

See 3 more Smart Citations

Opioids and Public Health: The Prescription Opioid Ecosystem and Need for Improved Management

2021

Self Cite

View full text Add to dashboard Cite

show abstract

Optimiser la gestion des opiacés en péri-opératoire

Lavand’homme

2021

Anesthésie & Réanimation

View full text Add to dashboard Cite

Preoperative Predictors of Prolonged Opioid Use in the 6 Months Following Total Knee Arthroplasty

Larach

Kertai

Billings

et al. 2023

The Clinical Journal of Pain

View full text Add to dashboard Cite

Objectives: Prolonged postoperative opioid use increases risk for new post-surgical opioid use disorder. We evaluated preoperative phenotypic factors predicting prolonged postoperative opioid use. Methods: We performed a secondary analysis of a prospective observational cohort (n=108) undergoing total knee arthroplasty (TKA) for osteoarthritis with 6-week and 6-month follow-up. Current opioid use and psychosocial, pain, and opioid-related characteristics were assessed at preoperative baseline. Primary outcomes were days/week of opioid use at follow-up. Results: At 6 weeks, preoperative opioid use and greater cumulative opioid exposure, depression, catastrophizing, anxiety, pain interference, sleep disturbance, and central sensitization were significantly associated with more days/week of opioid use after controlling for contemporaneous pain intensity. These predictors, and prior euphoric response to opioids, were also significant predictors at 6 months. All 6-week predictors except anxiety remained significant after controlling for preoperative opioid use; at 6 months, cumulative opioid exposure, catastrophizing, pain interference, and sleep disturbance remained significant after this adjustment (p’s <0.05). In multivariable models, a psychosocial factor reflecting negative affect, sleep, and pain accurately predicted 6-week opioid use (AUC=0.84). A combined model incorporating psychosocial factor scores, opioid-related factor scores, and preoperative opioid use showed near-perfect predictive accuracy at 6 months (AUC=0.97). Discussion: Overall, preoperative psychosocial, pain-related, and opioid-related phenotypic characteristics predicted prolonged opioid use following TKA.

show abstract

Persistent Postoperative Opioid Use

Cited by 12 publications

References 14 publications

Opioids and Public Health: The Prescription Opioid Ecosystem and Need for Improved Management

Opioids and Public Health: The Prescription Opioid Ecosystem and Need for Improved Management

Optimiser la gestion des opiacés en péri-opératoire

Preoperative Predictors of Prolonged Opioid Use in the 6 Months Following Total Knee Arthroplasty

Contact Info

Product

Resources

About