Category Archives: Surgery

Wide Variation in Opioid Prescribing for Pain Relief Following Knee Arthroscopy

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PainRelief.com Interview with:
Benjamin Ukert PhD
Assistant Professor
Department of Health Policy and Management
Texas A&M

Mucio Kit Delgado, MD, MS
Department of Emergency Medicine
Perelman School of Medicine
University of Pennsylvania

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

Response: The opioid epidemic has received a lot of attention and many state policies have been passed to address excessive opioid prescribing and highlight the dangers of opioid use initiation for those who have never been exposed to opioids. We also now know that most patients prescribed opioids for post-operative pain have significant quantities of pills leftover. One study showed that after knee arthroscopy, 50% of patients took no opioids, and 90% took less than 5 pills (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190545/).

We thought to investigate whether overprescribing is still common, and asked the question whether we now observe low levels of prescribing following knee arthroscopy and whether there are differences in prescribing practices across states.

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Total Hip Replacement Can Be Safely Performed with Minimal Opioids for Pain Relief

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MedicalResearch.com Interview with:
Andrew Wickline MD FAAOS
New Hartford, NY 13413

MedicalResearch.com:  What is the background for this study?  What are the main findings?

Response: Joint replacement has long been synonymous with pain relief–but not until 6-12 weeks after surgery.  Many patients put off joint replacement due to fear and anxiety–particularly about the possible pain after surgery often seen in the first several months.  Opioids have long been the mainstay of controlling pain after surgery but are associated with significant side effects and risk for addiction and injury. 

Our study shows that with our comprehensive protocol, 97% of patients can have successful surgical recovery with little to no opioids being necessary to stay comfortable.  Additionally, it shows that 94% of patients can go home within 24 hours and 95% will likely need no post-operative therapy to recover.

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Business Model Can Help With Pain Relief Decisions After Surgery

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Dr. Schug

PainRelief.com Interview with:
Professor Stephan A Schug MD FANZCA FFPMANZCA EDPZ 
Emeritus Professor and Honorary Senior Research Fellow
Anaesthesiology and Pain Medicine
Medical School  University of Western Australia

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

Response: This paper is the result of applying a widely used tool in operations research, Multi-Criteria Decision Analysis (MCDA), to a medical problem, namely the use of parenteral analgesics in postoperative pain management. MCDA is a modelling approach which is aimed at achieving evidence-based decisions in settings of multiple conflicting criteria. It is commonly applied to decisions in politics and business; one of our co-authors is Lawrence D Phillips from the London School of Economics and Political Sciences, where he uses this methodology in these settings. However, there is increasing use of this methodology in medicine now, in particular in assessment of medicines with obviously conflicting criteria such as efficacy, adverse effects, safety and even price. The methodology has been applied to a number of medicine (eg psychoactive drugs) and considered by the European Medicines Agency (EMA).

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Study Finds Common Sports Procedures Can Be Performed with No Opioids for Pain Relief

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PainRelief.com Interview with:

Kelechi R. Okoroha, M.D. 
Division of Sports Medicine
Department of Orthopedic Surgery
Henry Ford Health System

Dr. Okoroha

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

Response: The United States is in the midst of an opioid epidemic. Postoperative prescriptions following surgery is thought to have a direct role in the availability and exposure of opioids to the general population. This study was created in order to assess the viability of having common sports surgeries without the use of opioids.

PainRelief.com: What are the main findings?

Response: Our studies main findings were that common sports procedures can be performed with little or no opioids. 45% of patients did not require breakthrough opioid medication and all patients were satisfied with their pain management. Factors that were associated with requiring opioids included history of anxiety/depression.

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Study Tests Pain Relief by Coating Joint Implants with Pain Medication

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PainRelief.com Interview with:

Ebru Oral, PhD
Associate Professor, Orthopaedic Surgery
Associate Director, Harris Orthopaedic Laboratory
Massachusetts General Hospital, Boston, MA,
Harvard Medical School, Cambridge, MA

Ebru Oral, PhD Associate Professor, Orthopaedic Surgery Associate Director, Harris Orthopaedic Laboratory Massachusetts General Hospital, Boston, MA, Harvard Medical School, Cambridge, MA
Dr. Oral

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

Response: This study focuses on the possibility of delivering analgesics from the polymeric implant surfaces used in total joint arthroplasty. Currently, there are multi-modal regimens for controlling pain during and after surgery, including peri-articular injections and systemic medications.

The study shows that it is possible to accomplish the delivery of the commonly used drug bupivacaine from the implants at relevant concentrations. The long-term goal is to provide this material as a tool in controlling pain locally so that the use of systemic opioid medications can be decreased.

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Variety of Pain Relief Medications Reduced Opioid Usage in Trauma Patients

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PainRelief.com Interview with:
Christine S. Cocanour, M.D., F.A.C.S., F.C.C.M.
Division of Trauma, Acute Care Surgery and Surgical Critical Care 
UC Davis Health

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

Response: Our critical care pharmacists (Duby, Hamrick and Lee) and surgeons (Cocanour, Beyer) wanted to decrease our use of opioids without compromising pain control in our trauma patients—especially those that were admitted to the ICU.  To help make more appropriate choices we put together an order set that was a multimodal approach to pain management. 

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SEAL Procedure Gives Pain Relief To Some After Failed Back Surgery

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MedicalResearch.com Interview with:
"Personal Injury Back Pain" by SanDiego PersonalInjuryAttorney is licensed under CC BY-SA 2.0
Michael Perloff, MD PhD
Assistant Professor of Neurology
Interventional Pain Management
Boston University School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Low back pain is very common. Patients with chronic low back pain that does not benefit from physical therapy, medications, or injections, often get spine surgery. If surgery fails to help (Failed back surgery syndrome-i.e. continued low back and leg pain after surgery), options for pain relief become more complex.

Typically, patients with failed low back surgery syndrome have tried complex procedures, repeat surgery or technology implants as their main options.

The SEAL procedure is a shortened, simple procedure (done in about 20 minutes) that can help as treatment for failed back surgery symptoms. In the published case series of 30 patients, some patients achieved very good, sustained, pain relief. Continue reading →