Patients today expect treatment for pain as part of the standard of medical care. Indeed, adequate relief from pain is an established patient-satisfaction metric. In recent years doctors have frequently prescribed opioids for acute post-operative pain and other painful conditions in the emergency department and primary care settings.
However, opioid use for acute pain is associated with increased risk of long-term opioid use, which can lead to death from overdose. The dramatic increase in opioid prescribing over the past 15 years is a driver of the epidemic of drug overdose deaths. This public health epidemic has led to the reconsideration of what should be the best practices for prescribing opioids for acute pain.
A recent study from the University of Michigan found that 1 in 7 cancer patients who received a lung resection and who were “opioid naïve” at the time of surgery became new persistent opioid users. They continued to use the opioid prescription even after all wounds had healed and physical recovery was complete. Thus, opioid abuse should be considered a postoperative complication as common as others, such as atrial fibrillation.
The Michigan researchers suggested that strategies be developed and standardized among all caregivers to educate patients about the risks of using opioids, alternatives to opioids, managing expectations for pain after surgery, and instructions for proper disposal of unused pills.
Subscribers to UpToDate® already have access to the latest research and protocols for prescribing opioid pain medications. Clinicians wishing to brush up their knowledge of these drugs and the risks attendant in prescribing them to patients have a wealth of information at their fingertips.
For instance, the UpToDate topic “Prescription of opioids for acute pain in opioid naïve patients,” updated in January 2018, includes precise, detailed guidelines for physicians considering opioid pain medications for their patients. The entry covers such topics as risk of long-term opioid use, excessive prescription, level of pain, choice of opioid, duration of opioid therapy, strategy for pain control, and patient instruction.
The UpToDate library contains lengthy, substantive articles on opioid prescribing:
Responsible prescribing of pain medications
- Prescription drug misuse: Epidemiology, prevention, identification, and management
- Abuse deterrent opioids
- Approach to the management of chronic non-cancer pain in adults
- Prescription of opioids for acute pain in opioid naïve patients
- Use of opioids in the management of chronic non-cancer pain
- Cancer pain management: General principles and risk management for patients receiving opioids
- Perioperative uses of intravenous opioids in adults
Diagnosis and management of patients with opioid use or abuse issues
- Management of acute pain in the patient chronically using opioids
- Opioid use disorder: Epidemiology, pharmacology, clinical manifestations, course, screening, assessment, and diagnosis
- Substance use disorder in adolescents: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis
- Pharmacotherapy for opioid use disorder
- Psychosocial interventions for opioid use disorder
- Substance misuse in pregnant women
Opioid withdrawal and overdose
- Clinical assessment of substance use disorders
- Opioid withdrawal: Clinical manifestations, course, assessment, and diagnosis
- Medically supervised opioid withdrawal during treatment for addiction
- Prevention of lethal opioid overdose in the community
- Acute opioid intoxication in adults
- Opioid intoxication in children and adolescents
- Opioid withdrawal in adolescents
- Testing for drugs of abuse (DOA)
- Opioid withdrawal in the emergency setting
- Methadone substitution therapy of opioid use disorder during pregnancy
In UpToDate’s “What’s New” series, clinicians will find entries on:
- Appropriate use of opioids for refractory restless legs syndrome in adults (February 2018)
- Efficacy of long-acting naltrexone compared with buprenorphine for opioid use disorder (January 2018)
- Overprescription of opioids in children (December 2017)
- Misuse of prescribed opioids (September 2017)
This is the last post in our three-part series on current best practices in pain management with opioid medication. Contact us if you’re interested in an UpToDate subscription for your practice or hospital, or if you want to find out more about Emmi programs for patients getting prescription opioids.