Postprocedural Opioid-Prescribing Practice in Nail Surgery

Abstract

Background: Ingrown toenails are a common condition requiring outpatient procedures in podiatric medical clinics. To prevent recurrence, chemical matrixectomy is often recommended. Postprocedural pain management is largely based on preferences rather than on a formal guideline. This study aims to explore the postprocedural prescribing behavior among practicing podiatric physicians to foster future guideline and policy development. Methods: We administered an open, voluntary, anonymous questionnaire via an online survey platform that included a common nail procedure scenario (chemical matrixectomy) and a prescribed demographics section. Podiatric physicians were asked what they would prescribe to manage postprocedural pain. Opioid and nonopioid options were provided. We developed two multiple logistic regression models to identify associations between prescriber characteristics and prescribing opioids after “standard” chemical matrixectomy. Results: Of the 860 podiatrists who completed the survey, 8.7% opted to prescribe an opioid. Hydrocodone was most commonly chosen. A median of 18 opioid pills were prescribed. No prescriber characteristics were associated with prescribing opioids after chemical matrixectomy scenario. There is a large discrepancy and knowledge gap in the literature on the optimal postprocedural pain management for outpatient procedures, including procedures in specialties such as dentistry and dermatology. The median number of opioids prescribed by podiatrists is higher than that by dentists for management of third molar extraction. In contrast, opioid-prescribing behavior among the 8.7% of respondents is similar to dermatologic management of postprocedural pain in Mohs surgery. Conclusions: Podiatric physicians cannot assume that their prescribing of opioids does not affect the opioid abuse problem in the United States. The presented study serves to be an initiation for procedure-specific opioid prescription benchmarking to foster future guideline and policy development. After nail procedures, opioids should not be routinely prescribed.

Concomitant Use of Spasmolytics and Opioids for Postoperative Pain After Foot and Ankle Surgery: Fair or Foul?

“…It remains up to the podiatric physician to assess their patients' opioid history, pain tolerance, and comorbidities to formulate a patient-centric and procedure-focused approach to determine which nonopioid analgesics and opioids are best for managing their patients' postoperative pain. [17][18][19][20] Financial Disclosure: None reported. Conflict of Interest: None reported.…”

Podiatry and the Opioid Epidemic: A Call to Action

“…3,6 Several studies have demonstrated that the excess opioid prescribing, which has fueled the United States opioid epidemic at its origin, continues to be a serious problem, [7][8][9] including within our own profession. [10][11][12][13] My experiences with excess opioid prescribing and opioid misinformation began while on a clerkship in 2014. I was working with the chief resident at an "elite" podiatry residency program.…”

“…At minimum, please inform your prescribing practice by reading the published articles in the three Opioid Editions of JAPMA to learn more about how your peers treat postoperative pain as well as some helpful tips and tricks. [11][12][13][14][15]…”