Tailoring Opioid Prescriptions to Patients’ Perception of Pain

By Jonathan Springston, Editor, Relias Media

Prescribing opioids to patients after surgery based on perception of pain rather than based on type of surgery led to an increase in patient satisfaction regarding pain management and less waste of unused pills.

In a recent study, researchers enrolled 229 patients admitted for 48 hours or longer after elective surgery. Procedure types were gynecologic, colorectal, thoracic, and urologic. When patients were discharged, they received prescriptions for nonopioids and opioids based on their consumption of the latter one day before discharge. If patients took zero oral morphine milligram equivalents (MME) one day before discharge, then they received five 5-mg oxycodone pill-equivalents. If patients used one to 29 MME, then they received 15 5-mg oxycodone pill-equivalents. If patients took 30 or more MME, then they received 30 5-mg oxycodone pill-equivalents. Researchers also sought to improve proper disposal of unused opioids. Patients received education and follow-up phone calls, and were directed to drop-boxes where they could leave unused pills.

Overall, 213 of 229 patients reported they were satisfied with how they could manage their pain. Satisfaction was especially high among low-level opioid users. Overall, 95% of subjects used nonopioid analgesics. Additionally, 138 patients did not use all the pills prescribed; 114 used an FDA-appropriate disposal method, and 58 used the drop-box. Out of about 2,600 total opioid pills dispensed, patients only kept 187.

Surgeons play a central role in the efficacy of this approach, from setting pain expectations for patients (i.e., there likely never will be zero pain; at least a little pain should be expected) to prescribing nonopioid alternatives (not just recommending the alternatives, but writing a prescription) to explaining how to properly dispose of unused pills and why that is important (e.g., keep drugs out of the water supply and trash, keep kids away from pain pills).

Read more about this investigation and how these methods might apply to outpatient settings in future issues of Same-Day Surgery.