Seemingly Simple Strategy Cuts Opioid Use Without Worsening Pain

Study shows that reducing the amount of opioids doesn't result in more pain.

Three anesthesiologists from the University of Virginia (UVA) Health System have taken the opioid addiction fight into their own hands.

Opioid overdoses kill 91 Americans every day, according to the US Centers for Disease Control and Prevention (CDC). Various US institutions have put all hands on deck to cut that number. The UVA team implemented a seemingly simple tactic—they reduce the amount of opioids given to patients after surgery.

“There is very clear evidence that people can become opioid dependent because of the drugs they get during and after surgery,” Marcel Durieux, MD, PhD, one of the UVA anesthesiologists, said in a news release.

A total of 101,484 surgical procedures at UVA were examined. All of the patients had received general anesthesia. Between March 2011 and November 2015, when the surgeries took place, the average amount of opioids given to patients was reduced by 37%.

The patients, however, didn’t suffer from more pain due to the prescription painkiller cut. In fact, pain scores actually improved. When asked to rate their pain on a scale of zero to 10, patients’ average score was reduced from 5.5 to 3.8 during the study time frame.

But how was the team able to reduce opioids by over one-third yet still see better pain scores?

Durieux said that two factors came into play. For one, previous studies have shown that opioids actually make patients more sensitive to pain—a phenomenon that researchers don’t quite understand. The second factor was that the patients were given non-opioid painkillers, including over-the-counter medications like acetaminophen and lidocaine. During the course of the study, the average non-opioid painkiller amount given after each surgery increased by 120%.

The payoff with this opioid reduction strategy is that there is a lower risk of addiction. However, Durieux acknowledged that it can’t be applied to every patient, due to potential bleeding and kidney problem risks that come with certain medications.

“I think that by substantially limiting opioids during surgery, we’ve made an important step in addressing that problem,” Durieux concluded.

This isn’t the first time that UVA anesthesiologists have succeeded in limiting the amount of opioids in their hospital. In 2013, a guide for patients undergoing colorectal surgery, called the Enhanced Recovery After Surgery program, was implemented. One of the main stages of the guide was to develop a pain relief plan, including diminishing the use of opioids.

The news release was provided by the UVA.

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