If you have had one of a number of common surgical procedures – a simple mastectomy, open appendectomy, gallbladder removal, or total hip or knee replacement – you are at increased risk of developing chronic opioid use.
In fact, even having a baby with a cesarean delivery increases your chances of becoming addicted to painkillers.
The findings were published in July in JAMA Internal Medicine.1 Led by Dr. Eric C. Sun of Stanford University School of Medicine, the researchers examined health claims for 641,941 privately insured surgical patients who had not been prescribed an opioid for at least one year prior to their surgery. They were compared with a control group of 18 million people who had not surgery and who had not been prescribed opioids for at least a year.
They considered a patient to be a chronic opioid user if they had filled at least 10 prescriptions or more, or more than a four-month supply, beyond the first 90 days after surgery. Painkiller use generally is expected the first 90 days, although the researchers stress that doctors should try other methods of pain control whenever possible. This is especially true for patients predisposed to addiction or who have abused other substances in the past.
Surgeries with greatest risk of developing opioid use were total knee replacement (1.4 percent, or five times more likely than the study’s control group) and gallbladder removal (1.2 percent, or 3.5 times as likely as the control group). Those giving birth via cesarean section had the smallest risk. Four other common surgeries included in the study were found to have no greater risk of opioid dependence: prostate resection (TURP), cataract, functional endoscopic sinus surgery (FESS) and laparoscopic appendectomy.
The authors stressed that overall, risk of developing chronic opioid use remained low – less than one half of one percent for most procedures. Their intentions are not to discourage people from having lifesaving surgeries. But they do want surgeons to take heed of their findings and closely monitor their patients for opioid abuse in the post-surgical period.
If you already are in the throes of opioid addiction stemming from a painkiller prescription after one of these surgeries, take comfort in knowing you are not alone. You have nothing to be ashamed of and owe it to yourself to seek help. Everybody deserves the chance to recover.
Prior Substance Abuse, Depression Magnify Risk
The study showed that some groups of patients did have additional increased risk of developing opioid abuse after the surgeries, including men, patients over 50, any patient with a history of substance abuse before surgery, patients living with depression and patients already taking benzodiazepines (anxiety medications such as Xanax and Ativan) or antidepressants.
This study produced data previous studies had not, as these subjects were considered “opioid naïve” because they had not filled an opioid prescription one year prior to the surgery date.
The authors analyzed pharmacy records and specifically looked at prescriptions for fentanyl (patch and oral form), hydrocodone, hydromorphone (oral), methadone, morphine, oxymorphone and oxycodone. Cough medicines containing hydrocodone were not included in the analysis. Analgesics containing codeine also were excluded.
The authors admitted “we do not know if they had used any opioid prior (to the one year period before the surgery date in which prescriptions records were analyzed) or whether they used opioids surreptitiously in the year prior to surgery.”
The mean age of the surgical patients was 44, and 76 percent of them were women. About a quarter of the surgical patients suffered from hypertension, 12 percent with chronic obstructive pulmonary disease (COPD), almost 12 percent depression, 10 percent diabetes, 4 percent cancer and 3 percent liver disease.
Class Prepares Breast Cancer Patients for Pain
In a Stanford news release,2 Sun said he tries to use regional anesthetics whenever possible to reduce the need for post-surgery painkillers. He also encourages patients to simply take over-the-counter pain relievers like Tylenol for pain.
Study co-author Beth Darnall, author of the book “Less Pain, Fewer Pills: Avoid the Dangers of Prescription Opioids and Gain Control over Chronic Pain,” was quoted in the news release as saying, “Even when taken exactly as prescribed, opioids carry significant risks and side effects. Ideally, opioids are avoided in treating chronic pain, and pain treatment should emphasize comprehensive care, including physical therapy, pain psychology and self-management strategies.”
Darnall is studying women enrolled in a pain psychology class at Stanford called “My Surgical Success.” The class helps women anticipate the pain associated with breast cancer surgery and helps them plain for it.
“It turns out that a lot of chronic pain develops from surgery, and pre-surgical ‘catastrophizing’ is a major risk factor for having a lot of pain,” Darnall said in the news release. “We hope that by optimizing patients’ psychology – and giving them skills to calm their own nervous system – they will have less pain after surgery, need fewer opioids and recovery quicker.”
In the study, the researchers called pain “subjective,” hinting it can at least partially be controlled using mind over matter. “Patients undergoing surgery are clearly at risk for post-surgical pain, a subjective experience that is modulated by many factors, including psychological, behavioral and medical characteristics.”
1. Sun, E. et al. (2016, July 11). “Incidence of and Risk Factors for Chronic Opioid Among Opioid Naïve Patients in the Post-Operative Period.” JAMA Internal Medicine. Retrieved Aug. 4, 2016, from http://archinte.jamanetwork.com/article.aspx?articleid=2532789
2. White, Tracie. (2016, July 11. “Surgeries found to increase risk of chronic opioid use.” Stanford Medicine News Center. Retrieved Aug. 4, 2016, from https://med.stanford.edu/news/all-news/2016/07/surgery-found-to-increase-risk-of-chronic-opioid-use.html
Written by David Heitz