Targets to eliminate pain after surgery are a major cause of the opioid crisis in several countries, according to a new report co-authored by Professor Lesley Colvin of the University of Dundee. Published in The Lancet, the report brings together global evidence detailing the role of surgery in the opioid crisis. The authors conclude that pain management has contributed substantially to the crisis due to inadequate prescription of opioids.
Chronic postoperative pain is a growing problem as the population ages and more operations are performed. It can occur after any type of surgery. Each year, 320 million people were operated on and chronic pain occurs in 10% of cases.
Prescription opioid use worldwide doubled between 2001-2013 (from 3 billion to 7.3 billion daily doses per year) and doctors in many countries around the world administer higher-than-needed drugs for to pain control, increasing the risks of misuse or diversion.
The authors have called for interventions that include specialized pain clinics, drug control policies, and improved medical training. opioid prescriptionand new methods of pain control, including alternative pain relief medications to curb the crisis.
“Most people are aware of this opioid epidemic in the United States, where there has been a huge increase in strong opioids prescribed for the treatment of chronic pain, ”said Professor Colvin, president of pain medicine at the University’s School of Medicine.
“One of the things we’re trying to do is find out why this has happened. There’s no doubt one of the collaborators has been the people who had surgery. Then they need strong painkillers and sometimes those painkillers don’t stop. when they should be.
“People continue, sometimes with chronic pain, but they continue to have higher doses of opioids, so they end up having side effects, problems with misuse, tolerance and opioids-induced hyperalgesia.
“A better understanding of the effects of opioids at neurobiological, clinical and social levels is needed to improve future patient care. There are research gaps that need to be addressed to improve the current situation of opioids. , we need to better understand opioid tolerance and induced hyperalgesia to develop treatments to relieve pain that work in these conditions.
“We also need large population-based studies to help better understand the link between opioid use during surgery and chronic pain, and we need to understand what predisposes some people to opioid abuse so we can provide an alternative pain relief during surgery for these patients.These recommendations affect many areas of the opioid crisis and it could also benefit from the wider crisis. “
Chronic pain often begins as acute postoperative pain that is difficult to control and becomes a persistent pain disorder with characteristics that do not respond to opioids. In response to this pain, doctors often prescribe higher levels of opioids, but this can lead to tolerance and opioid-induced hyperalgesia (a counterintuitive increase in pain in line with increased opioid use), creating a cycle. increased pain and increased opioid use where pain remains poorly managed.
The opioid crisis in the United States began in the mid-1990s and early 2000s, when inadequate pain relief was seen as a marker of low-quality health care. Opioids are now one of the most prescribed drugs in the U.S. with similar, though less marked, trends in other high-income countries, including the United Kingdom. In comparison, many low-income countries around the world have little access to opioids and cannot provide adequate resources. pain relief.
There are also marked international differences in opioid prescription after surgery. Data comparing a U.S. hospital and a Dutch hospital found that 77% of patients who repaired hip fractures at the U.S. hospital received opioids, while toward the Netherlands hospital and 82% of American patients received opioids after ankle fracture repair compared with 6% of Dutch patients. Despite these differences, patients in each of these countries show similar levels of satisfaction with pain control.
In addition, excessive amounts of opioids are prescribed to American patients after surgery. Studies between 2011-2017 found that 67-92% of patients with U.S. surgery reported that they did not use all opioid tablets, which typically left 42-71% of the prescribed pills unused.
University of Dundee
Citation: Inadequate treatment of pain after surgery, one of the main causes of opioid crisis (2021, June 11), recovered on June 12, 2021 at https://medicalxpress.com/news/2021-06- inappropriate-pain-surgery-major-opioid.html
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