By Michael Hunter MD: For Complete Post, Click Here…

A NEW META-ANALYSIS SHOWS THAT TAKING OPIOIDS after minor to moderate surgery does not reduce pain (compared with over-the-counter medicines) after the patient leaves the hospital. Moreover, opioid use puts patients at a higher risk for side effects such as nausea, vomiting, and constipation.

We in the United States often prescribe narcotic pain medicines after surgery. In contradistinction, many other countries rarely prescribe opioid medications after surgery. Is it time for Americans to change their approach to postoperative pain management?

The widespread habit of prescribing narcotics at discharge after surgery in North America has contributed to a crisis of overdose, addiction, and crime.

A new analysis of a collection of studies finds no evidence that pain control regimens that include opioid narcotic pain medicines are superior to over-the-counter analgesics.

Opioids: More harms than benefits

Researchers from the McGill University Health Centre (Canada) conducted a study to estimate the impact of post-discharge opioid use on self-reported pain intensity and adverse events compared with opioid-free pain management.

Publishing in The Lancet, the investigators combined the results of 47 randomized clinical trials comparing pain management approaches with or without opioids.

Thirty studies involved relatively minor procedures (mostly dental), while 17 involved procedures of moderate extent (including general and orthopedic surgery).

Here are the striking results:

• Opioids did not impact patient-reported postoperative pain levels (compared with simple over-the-counter analgesics.
• Opioids increase the risk of nausea, vomiting, constipation, drowsiness, and dizziness.
• There appeared to be no differences in other aspects of recovery (patient satisfaction, ability to do daily activities, and emergency department visits).

My take

We can do better. The researchers note that six percent of surgical patients (who are opioid-naïve) become persistent opioid users after receiving a prescription at surgical discharge.

Moreover, there is waste (that can get into our water supply): The study authors explain that patients do not use up to 70 percent of postoperative narcotics. In addition, criminals may gain access to these pills.

Clinicians need to mitigate postoperative overprescribing, even as we aim to ensure that our patients have adequate pain relief.