Do patients who continue to use opioids use after surgery do so to control post-operative pain — or because a pre-existing behavioral or pain disorder makes them vulnerable to opioid use? A new JAMA Surgery study suggests it could be the latter.
New, persistent opioid use after surgery may be associated less with surgical pain than with other addressable, patient-level predictors, according to a study conducted by researchers from the University of Michigan Medical School, Ann Arbor. Risk factors include behavioral disorders such as pre-operative tobacco use, alcohol and substance abuse disorders, mood disorders and anxiety, as well as pre-operative pain disorders.
The researchers calculated the incidence of persistent opioid use among patients who had not used opioids previously. Among the more than 36,100 adult patients included in the study — the patients were predominately female (66%) and white (72%), with an average age of 45 — about 6% continued to use opioids more than 3 months after their surgery.
More than 29,000 (80%) received minor surgical procedures, and more than 7,100 (20%) received major procedures. The rates of new persistent opioid use were similar between the 2 groups, ranging from 5.9% to 6.5%. (By comparison, the incidence in the non-operative control group was only 0.4%.) Because the rates did not differ significantly between major and minor procedures, the data suggest prolonged post-operative opioid use may be due to factors other than surgical pain.
"This suggests its use is not due to surgical pain but addressable patient-level predictors," the authors write. "New, persistent opioid use represents a common but previously underappreciated surgical complication that warrants increased awareness."