Category Archives: Surgery

Opioid Prescriptions by Surgeons for Post-Op Pain Relief Decline, but Progress Has Slowed

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PainRelief.com Interview with:
Kao-Ping Chua, MD, PhD
Susan B. Meister Child Health Evaluation and Research Center
Department of Pediatrics, University of Michigan Medical School
Ann Arbor MI 48109

Dr. Kao-Ping Chua
Dr. Kao-Ping Chua

PainRelief.com: What is the background for this study?

Response: Surgery is one of the most common reasons for opioid prescribing. Ensuring the appropriateness of opioid prescribing by surgeons is important, as prescriptions that exceed patient need result in leftover pills that can be a source for misuse or diversion. Although there have been numerous recent policy and clinical efforts to improve opioid prescribing by surgeons, recent national data on this prescribing are unavailable.

In this study, we analyzed a comprehensive prescription dispensing database that captures 92% of prescriptions from U.S. pharmacies. From 2016 to 2022, we found that the rate of surgical opioid prescriptions at the population level declined by 36%, while the average amount of opioids in these prescriptions declined by 46%. As a result of these two changes, the total amount of opioids dispensed to surgical patients declined by 66%.

However, there were two caveats:

First, the decline in surgical opioid prescribing was most rapid before 2020 and has slowed since then.

Second, the average surgical opioid prescription in December 2022 still contained the equivalent of about 44 pills containing 5 milligrams of hydrocodone, far higher than most patients need after surgery.

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Study Finds Modest Decrease in Opioid Prescriptions after Insurer Opioid Prescribing Limit

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PainRelief.com Interview with:
Kao-Ping Chua, MD, PhD
Susan B. Meister Child Health Evaluation and Research Center
Department of Pediatrics, University of Michigan Medical School
Ann Arbor MI 48109

Dr. Kao-Ping Chua
Dr. Kao-Ping Chua

PainRelief.com: What is the background for this study?

Response: Almost every state has implemented a policy to restrict the duration of opioid prescriptions for acute pain, as have many major insurers. Prior studies have evaluated the effects of these limits on opioid prescribing, but there are no large-scale studies that have evaluated the effects of limits on patient-reported outcomes, such as pain control.

In this study, we evaluated the effect of a major Michigan insurer’s
5-day opioid prescribing limit in February 2018 on both opioid prescribing and patient-reported outcomes after surgery.

To do so, we leveraged our access to a statewide surgical registry in Michigan that has been collecting data on opioid prescribing and patient-reported outcomes from adult patients undergoing common general surgical procedures since 2017.

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Miami Thoracic Surgeons Achieve Pain Control With Minimal or No Opioids

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PainRelief.com Interview with:
Dao Minh Nguyen, MD, MSc FRCSC FACS
Thoracic Cancers Group Go-Lead
Sylvester Comprehensive Cancer Center
University of Miami Miller School of Medicine

PainRelief.com: What is the background for this study?

Response: Patients undergoing thoracic surgery operations experience significant acute incisional pain as well as chronic pain many months after.

The mainstay of treatment is based on frequent use of potent and addictive-prone opioids such as hydromorphone, oxycodone at high dosages and long duration.
There is a high incidence of persistent opioid users and chronic opioids users in surgical patient population. This certainly contributes to the opioid epidemic in the USA and worldwide.

We implemented a peri-operative care protocol for patients undergoing thoracic surgery operations called Enhanced Recovery after Thoracic Surgery (ERATS). The overarching goal of ERATS is to streamline care for thoracic surgery patients particularly in the postoperative period to mitigate pain with opioid-free strategy, to minimize postoperative complications, rapid return to baseline states and safe, early discharge home. This protocol follows guidelines of the ERAS principles and is developed for thoracic patients to address their unique needs.

Once pain is adequately addressed with opioid-free strategy with elimination of opioid-associated side effects, rapid recovery after surgery can be achieved.

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Sciatica: Surgical Treatment May Provide Only Temporary Pain Relief

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PainRelief.com Interview with:
Chang Liu
Researcher, PHD Student
University of Sydney

PainRelief.com: What is the background for this study?

Response: Sciatica is a common condition caused by lumbar nerve root compression and/or inflammation, usually due to a herniated disc. Non-surgical treatments, such as exercise, are recommended as the first step, with pharmacological and interventional options available if needed.

Surgery, specifically discectomy, is a common treatment for sciatica but evidence supporting its effectiveness is uncertain. 

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Painful Bunions: Risk Factors for Failure of Corrective Surgery

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Dr. Johnson

PainRelief.com Interview with:
Matthew Johnson, D.P.M.
Assistant Professor
Department of Orthopaedic Surgery
University of Texas Southwestern Medical Center

PainRelief.com: What is the background for this study?

Response: There is a paucity of literature attempting to characterize risk factors for nonunion of the Lapidus bunionectomy.

PainRelief.com: Would you briefly describe what is meant by a bunion?

Bunion with cornDermNet NZ image

Response: Bunions are a chronic painful bump that forms on the base of the big toe when the long metatarsal bone shifts toward the inside of the foot and the phalanx bones of the big toe angle toward the second toe.



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Acupuncture During Gynecology Cancer Surgery Reduced Post-Op Pain

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PainRelief.com Interview with:
Prof. Eran Ben-Arye MD
Co-founder and director of the Unit of Complementary and Traditional Medicine
Department of Family Medicine, Haifa
Director of the Integrative Oncology Program within the Haifa and Western Galilee Oncology Service, Lin Medical Center, Clalit Health Services
Chairperson of the Israel Society for Complementary Medicine of the Israel Medical Association

Prof. Ben-Arye

PainRelief.com: What is the background for this study?

Response: The study was part of an initiative whose stated goal was providing continuity of integrative oncology care to patients with gynecology cancer. Over the past 14 years we have been offering patients undergoing chemotherapy with integrative oncology treatments without charge, helping improve their quality of life and increasing their adherence to the conventional oncology treatment protocol.

The research presented in the current paper examined the introduction of the integrative treatment from as early as the time of cancer diagnosis and throughout the pre-surgical, surgical and post-surgical inpatient setting.
The integrative process was a collaborative effort, taking place together with a team of surgeons, anesthesiologists and nurses throughout all stages of peri-operative care of the gynecology oncology patient. 

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Novel Protocol Reduced Use of Opioid Pain Relievers After Knee and Shoulder Surgeries

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PainRelief.com Interview with:
Nicole Simunovic, MSc
On behalf of the NO PAin Principal Investigators

PainRelief.com: What is the background for this study?

Response: Orthopaedic surgeons prescribe more opioids than any other type of surgeon in North America. Opioids have the potential to be highly addictive and can cause serious harm or even death if taken in excess. The goal of our clinical study was to determine if an opioid sparing approach to postoperative pain management was safe and effective in patients undergoing arthroscopic knee and shoulder surgery.

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Policymakers Can Mitigate Prescription Opioid Misuse Associated with Delayed Dispensing for Pain Relief after Procedures

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PainRelief.com Interview with:
Kao–Ping Chua, MD, PhD
Department of Pediatrics
Susan B. Meister Child Health Evaluation and Research Center
University of Michigan Medical School
Department of Health Management and Policy
University of Michigan School of Public Health, Ann Arbor

PainRelief.com:  What is the background for this study? 

Response: Opioid prescriptions written by dentists and surgeons are almost always written for the immediate relief of acute pain after procedures. However, current federal and state laws allow these prescriptions to be dispensed well after the time that they are written. When this occurs, that could be a potential sign that the prescription was used in a time frame or for a reason other than intended by the prescriber, both of which are forms of prescription opioid misuse.

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Study Evaluates Long-Acting Bupivacaine for Pain Relief During Knee Replacement

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PainRelief.com Interview with:
Prof. Hemant G. Pandit, DPhil
Leeds Institute of Rheumatic and Musculoskeletal Medicine
Chapel Allerton Hospital, University of Leeds
Leeds, United Kingdom

Prof. Pandit

PainRelief.com:  What is the background for this study? 

Response:  Knee replacement is highly successful for treating severe arthritis. There are 100,000 people who undergo knee replacement surgery every year in the UK, with numbers set to rise significantly in future. It remains however a painful procedure with nearly half of patients reporting severe pain post-operatively. Currently pain control is provided by injecting a local anaesthetic of bupivacaine hydrochloride around the knee during surgery providing good pain relief for 12 to 24 hours. However, patients typically experienced the worst pain the next morning when they are encouraged to bend their knee and get out of bed. 

Liposomal bupivacaine is a local anaesthetic preparation which can provide sustained release of pain relief medication over a longer period of time (up to 72 hours). The drug is costly and is used in routine clinical practice in the USA with previous studies showing varying results with the use of LB. We therefore (researchers at the Universities of Oxford and Leeds) developed the SPAARK (Study of Peri-Articular Anaesthetic for Replacement of the Knee) Trial, to test whether liposomal bupivacaine would be more effective at managing the pain compared to current treatments in patients undergoing a knee replacement. 

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Total Knee Replacement: Outcomes by Age vs Co-Morbidities

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PainRelief.com Interview with:
Juan Ignacio, Teves
Agustin, Garcia-Mansilla
Italian Hospital of Buenos Aires

PainRelief.com:  What is the background for this study?

Response: It is well known that the increased life expectancy of the general population leads to an increase in the number of prosthetic replacement surgeries in the years to come. A concern of patients who consult for this type of procedure is whether age alone is a risk factor for this surgery and the literature is not conclusive about whether age or comorbidities are more important in postoperative results.

For this reason, we decided to compare two series of patients, some older than 80 years and others younger, to determine whether or not age influences the result of total knee replacement.

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