Surgeons who are wearing their rescue scalpels, their laparoscopic tools, or their other tools to repair or remove their cancers are well understood that pain is an inevitable part of the healing process. However, the risk of standard crisis for these highly effective analyzes continues to pose a risk to the current opioid crisis.
New research from Michigan Medicine could help clinicians mitigate this risk by identifying patients most likely to continue using opioids after their immediate recovery period.
"There is little research on needing more or less opioids from surgical patients, despite pressure in the field for personalized medicine," says first author Daniel Larach, MD, MTR, MA, resident of the SU at the time of study and now an assistant professor of clinical anesthesia at the University of Southern California.
"Often with opioid post-operative ordering, personalization enters the way, with surgeons using the same amounts for each person receiving a particular procedure."
He and the study team looked at data for more than 1,000 people who were undergoing an optional hysterectomy, thoracic surgery, or a full knee or hip replacement. Prior to its procedures, all patients provided demographic information and completed a number of screening questionnaires. They were given scores of depression, anxiety, fatigue, sleep disturbance, physical function, as well as the intensity of their pain on the overall site and surgery. The research team also measured how many pills were ordered per patient. Each patient was then contacted a month after surgery to assess the amount of optional pills they had worn.
"We found that there is a concern associated with the use of more opioids, which is very happy to see, but it is encouraging that this is something we could focus on," said Larach.
Other patient factors linked to increased opioid use included the younger age, vaginal race, college degree, alcohol and tobacco use, and sleep disturbance.
Chad Brummett, M.D., associate professor of anesthesiology and director of clinical anesthesia research and pain research, says that people may be knowingly or knowingly treating other conditions.
"The only thing we give them is opioids and we don't offer them alternatives or alternatives," he says. For example, behavioral care or other non-opioid medications could be offered to patients who are greatly concerned about the time of surgery for anxiety and pain as a result.
Brummett, senior author of the Annals of Surgical This paper also notes that this study found over-demand for opioids for all surgical procedures and correlation between the amount and use of the prescription.
"I think it's striking that you will see again that more you will prescribe, the more patients will take, even after adjusting these other risk factors," explains Brummett.
Larch and Brummett note that prescriptions are corrected by initiatives such as Opioid Michigan Participation Recipe Network (OPEN), which provides recommendations for recipes for different medical procedures, a critical first step. However, they say, there should be more research on specific patient factors that can be tackled in other ways.
Brummett says, "We are asking surgeons to learn about pain and behavioral health and to think about them in ways we have not already done. They will need an open mind."
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