Online Patient Materials Unlikely to Discuss Risk of Opioids Prescribed for Pain Relief Interview with:

Edward R. Mariano, MD, MAS (Clinical Research)
Chief, Anesthesiology and Perioperative Care Service and
Associate Chief of Staff for Inpatient Surgical Services
VA Palo Alto Health Care System
Professor of Anesthesiology, Perioperative and Pain Medicine
Stanford University School of Medicine
Palo Alto, CA  94304  What is the background for this study?  What are the main findings?

Response: Today, there is so much attention on the opioid epidemic, and patients and clinicians are constantly reminded about the dangers of opioids. Guidelines have recommended the provision of patient and caregiver education on pain management, especially on how to taper (safely decrease and eventually stop taking) opioids after surgery. With over 70 fellowship programs in regional anesthesiology and acute pain medicine, we assumed that there would be plenty of information for patients on safe opioid management online since most people use the internet to find health-related information. We conducted a rigorous search for online patient education materials related to safe opioid management, evaluated to reading level and content, and compared materials produced by fellowship programs to other online educational materials. Unfortunately, the average reading level for all materials we found was above the level recommended for patients (sixth grade or lower). Most fellowship programs in regional anesthesiology and acute pain medicine did not even offer online patient education materials and were less likely to describe overdose risk and opioid disposal. Less than half of all materials mentioned tapering or cessation of opioids after surgery (see visual abstract attached). What should readers take away from your report?

Response: Since our patients reliably go to the internet for information, we as a healthcare community need to get out there and put valuable information online that people can use. Overdoses due to opioids are a public health crisis, and direct-to-patient education on safe opioid storage, tapering, and disposal through the internet can make a difference. Fellowship programs should take the lead. As the institutions training the next generation of physician leaders in regional anesthesiology and acute pain medicine, one priority should be teaching fellows modern communication tools to help educate their patients and society in general. What recommendations do you have for future research as a result of this work?

Response: For this study, we focused on written materials only in order to assess readability, but we do not yet know what is the ideal format (e.g., video) for providing patient education. This preference may be influenced by a number of factors and should be studied. We also do not know the best location for patient educational materials online or how to most efficiently disseminate this information to people likely to benefit from it. Another important research question is when and how patients access information related to their own care as this may influence when to promote online educational materials to patients preparing for surgery. Is there anything else you would like to add?

Response: None of the authors has financial conflicts of interest to disclose. I currently serve on the Board of Directors for the American Society of Regional Anesthesia and Pain Medicine (ASRA), Chair of the Committee on Regional Anesthesia and Acute Pain Medicine for the American Society of Anesthesiologists (ASA), Speaker of the House of Delegates for the California Society of Anesthesiologists, and National Academy of Medicine Action Collaborative Countering the U.S. Opioid Epidemic. 


Gunjan Kumar, Kellie M Jaremko, Alex Kou, Steven K Howard, T Kyle Harrison, Edward R Mariano; Quality of Patient Education Materials on Safe Opioid Management in the Acute Perioperative Period: What Do Patients Find Online?, Pain Medicine, , pny296,

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Last Updated on March 8, 2019 by