Prescription Painkillers for Small Surgeries May Lead to Long-Term Use
(TORONTO) -- Older adults who receive pain medications after surgery may be at higher risk of becoming addicted, according to a new study published in the journal Archives of Internal Medicine.
Physicians often prescribe opioids, including codeine and oxycodone, after outpatient surgeries.
While these drugs are proven to be effective for temporary pain relief, they are also associated with side effects including sedation, constipation and breathing problems, as well as addiction.
Researchers analyzed data from nearly 400,000 Canadian patients ages 66 and older who received an opioid prescription within seven days of undergoing surgery for cataracts, gallbladder removal, prostate tissue removal or varicose vein stripping.
What they found was that more than 10 percent of the patients who received an opioid after a surgery were identified as long-term opioid users one year after surgery. They also found patients were 3.7 times more likely to use non-steroidal anti-inflammatory drugs on a long-term basis if they received a prescription for the drug within seven days after surgery.
"We tried to look at what some of the events are that start people on the road to acute or chronic use of opioids," said Dr. Chaim Bell, associate professor of medicine at University of Toronto and co-author of the study. "It's much easier to prevent the initiation of the medication than wean people off it later. Everyone should get pain relief, but the painkiller and the dose should be tailored to the specific patient."
The findings align with the general experience of Dr. David Maine, director of the Center for Interventional Pain Medicine. He said the decision to start and prescribe an opioid at any time is a serious one. Treatment goals should be clearly defined when a prescription is first written, to ensure safety and effectiveness of the medication -- and to minimize the risk of addiction.
"Generally with older patients, if starting an opioid, we set up a short interval follow-up to ensure tolerability of the medication as well as efficacy," said Maine. "If either of those are an issue then we make a change. Sometimes that change is discontinuing the medication entirely. Ultimately, I think the decision to stop an opioid analgesic is as important as the decision to start."
Dr. Timothy Collins of the Pain and Palliative Care Program at Duke University Medical Center said the results of the study are surprising since patients who undergo such small surgeries should be finished with their pain medications after 10 to 14 days.
"Changes in the way pain medications are prescribed such as linking the pain medication to a specific outcome would help," said Collins. "Patients would have to have better function, or significant improvement on a pain scale, in order to continue on the medication. Frequently patients just say 'I feel better' or 'it helps some' but do not have any other evidence that the medication is actually helping them function better."
One in five American adults received a painkiller prescription in 2006, totaling more than 230 million total prescription painkiller purchases.
And in 2010, the Centers for Disease Control and Prevention reported that the number of fatal opioid poisonings more than tripled from 4,000 in 1999, to 13,800 in 2006.
Lack of communication between surgeons and family physicians may contribute to excessive painkiller prescriptions, along with the potential addiction and abuse of them, Bell said. Communication barriers, such as hearing or cognition deficits in older patients, also may hinder patients' understanding of when it is appropriate to taper a pain medicine or take it only on an as needed basis, said Dr. Doris Cope, director of the Pain Medicine Program at University of Pittsburgh Medical Center.
The study emphasizes the importance of tailoring patient education on a case-by-case basis, as well as the need for careful coordination of medical care among a patient's surgeons, doctors and caregivers, said Cope. Hopefully, she added, "this can be better achieved in the offices of busy primary care physicians."
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