Most recent update: Tuesday, September 17, 2019 - 16:32

Bariatric News - Cookies & privacy policy

You are here

Opioid use

Bariatric patients increase use of opioids post-surgery

Calls for proactive management of chronic pain post-surgery

Patients who took chronic opioids for non-cancer pain and who underwent bariatric surgery, increased opioid use after surgery compared with before, according to a study in JAMA. Although it is not known if opioid use for chronic pain in obese individuals undergoing bariatric surgery is reduced, the authors called for proactive management of chronic pain in these patients after surgery.

Marsha A Raebel of Kaiser Permanente Colorado, Denver, and colleagues conducted a study to examine opioid use following bariatric surgery in patients using opioids chronically for pain control prior to their surgery. The study included 11,719 individuals 21 years of age and older who had bariatric surgery between 2005 and 2009, and who were assessed 1 year before and after surgery, with latest follow-up by December 31, 2010.

In the year before bariatric surgery, 56 percent of patients had no opioid use, 36 percent had some opioid use, and 8 percent had chronic opioid use. Among pre-surgery chronic users, 77 percent continued chronic opioid use after surgery. Relative to the year before surgery, the amount of opioid use by patients who were chronic opioid users before surgery increased by 13 percent the first year after surgery and by 18 percent across 3 post-surgery years.

"There are limited options for pain management available to bariatric surgery patients because non-steroidal, anti-inflammatory medications increase the risk of ulcers, particularly after bariatric surgery," said Raebel. "Given the increasing chronic usage rate reported in this study, it's clear that the medical community needs to develop better pain management programs for patients who use opioids long-term following bariatric surgery."

For the group with chronic opiate use prior to surgery, change in morphine equivalents before vs. after surgery did not differ between individuals who lost more than 50 percent of their excess body mass index vs. those who lost 50 percent or less.

Neither preoperative depression nor chronic pain diagnoses influenced changes in preoperative to postoperative chronic opioid use.

"We anticipated [that] weight loss after bariatric surgery would result in reduced pain and opioid use among patients with chronic pain,” the authors write. “However, patients with and without preoperative chronic pain, depression diagnoses, or both had similar increases in postoperative chronic opioid use after surgery as those without chronic pain or depression. One possible explanation is that some patients likely had pain unresponsive to weight loss but potentially responsive to opioids.”

"These findings suggest the need for better pain management in these patients following surgery."

In an accompanying editorial, Dr Daniel P Alford, from Boston Medical Center, discusses the importance of clinicians reducing or eliminating opioid use among patients when warranted.

"The safe and appropriate prescribing of opioids for chronic pain has become an important national priority. Although core competencies for pain management are being developed, knowing when and how to continue, change, or discontinue opioid therapy must be included in all clinician education efforts. Although Raebel et al are correct in reporting that better pain management strategies are needed, they also may have uncovered an equally important problem—the need to know if, when, and how to safely and effectively taper or discontinue opioid therapy for patients with chronic pain."

Want more stories like this? Subscribe to Bariatric News!

Bariatric News
Keep up to date! Get the latest news in your inbox. NOTE: Bariatric News WILL NOT pass on your details to 3rd parties. However, you may receive ‘marketing emails’ sent by us on behalf of 3rd parties.