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Right-sizing opioid prescriptions after surgery - Harvard Health

It’s common for doctors to prescribe opioid pain medications for their patients after surgery; however, prescribing large numbers of pills increases the possibility of dependence and overdose...

7/30/2021 8:00:00 PM

It’s common for doctors to prescribe opioid pain medications for their patients after surgery; however, prescribing large numbers of pills increases the possibility of dependence and overdose. HarvardHealth addiction

It’s common for doctors to prescribe opioid pain medications for their patients after surgery; however, prescribing large numbers of pills increases the possibility of dependence and overdose...

.Fortunately, researchers across the country have begun to establish evidence-based guidelines for how many pills should be prescribed. As an example, the Michigan Opioid Prescribing Engagement Network studied common surgeries performed across their state. By following patients and their reported discomfort, they have created a list of

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maximum quantities of opioid pillsto be dispensed after these surgeries. At first glance, the numbers of pills are surprisingly low — for example, no more than 10 pills after having one’s appendix removed. But the reality is that, for a patient with no other painful conditions and a straightforward appendectomy, that is all that is required to adequately treat the pain while reducing the risk of misuse and diversion.

Recent researchhas confirmed these findings. At the University of Pennsylvania, patients who had certain urologic or orthopedic procedures were enrolled in an automatic text messaging system. The messages asked about pain intensity, the number of opioid pills used, and each patient’s ability to manage their pain. The messages were sent once a week for up to four weeks, or until there was no further opioid use reported. The results were remarkable: even in the hospitals where there already was a relatively low number of pills given, about 60% of tablets were not taken, and very few patients required opioids seven days after their surgery. In addition, nearly a quarter of individuals who had orthopedic surgery, and almost half of those who had urologic procedures, didn’t use any opioids at all after their surgery. headtopics.com

Personalized medicine for post-surgical pain managementThis research gives me hope for several reasons. The first is that opioids are not always required for adequate management of acute pain and, if avoided entirely for patients who are comfortable without them, will reduce one’s exposure and chance of ever developing chronic opioid use or addiction. The second point is that, when opioids are needed, surgeons can feel confident that the lower pill counts recommended by the guidelines are adequate, and patients, too, should feel empowered to know what the recommended maximum opioid pill count is for the procedure that they are having. And finally, I am hopeful that we are getting closer to an era of assisted personalized medicine, where digital tools can check in with patients, ensure medications are being taken safely, and help us achieve the dual goals of adequate pain control while reducing the risk of addiction.

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