DECEMBER 27, 2024
LAS VEGAS¬—Surgeon and physician perceptions of patients’ postoperative pain suggest that inadequately managed pain negatively affects patient recovery and reflects a need for more effective, safer therapeutics, according to the findings of a recent study.
“One of the things we have to better understand is why surgeons are prescribing such a high dose of opioids, and what are their perceptions and what are their feelings around opioids? What’s the reason underlying
LAS VEGAS¬—Surgeon and physician perceptions of patients’ postoperative pain suggest that inadequately managed pain negatively affects patient recovery and reflects a need for more effective, safer therapeutics, according to the findings of a recent study.
“One of the things we have to better understand is why surgeons are prescribing such a high dose of opioids, and what are their perceptions and what are their feelings around opioids? What’s the reason underlying these large prescriptions, even with surgeons that are doing these more advanced pain management protocols?” said study author Vinod Dasa, MD, an orthopedic surgeon at Louisiana State University, in New Orleans, in an interview with Pain Medicine News.
Presenting at the 2024 annual PAINWeek conference, researchers described how they sought to better understand the challenges, barriers and facilitators related to managing postoperative acute pain in adults (poster 027). They also sought to identify how surgeons define inadequate acute pain management and their perceived effects on adult patients.
The researchers performed a cross-sectional study in which qualitative research methods were used to gather and analyze descriptions of acute pain management from surgeons. Purposive sampling identified 30 physicians who either specialized in general, orthopedic or plastic surgery; were involved in managing patients’ acute pain; had at least three years of experience in a surgical setting following completion of a residency or fellowship program; and spent at least 50% working time in a clinical setting with an average caseload consisting of at least 50% adult patients.
Surgeons were interviewed one-on-one for 60 minutes using an interview guide that addressed study objectives. The majority of the interviewees were white (73.3%) and male (96.7%) with nearly one-third practicing in the Northeastern United States. Only five surgeons reported being satisfied with currently available prescription medications for acute pain management, 19 were somewhat satisfied and three were unsatisfied. One orthopedic surgeon reported being “totally displeased” with the currently available treatment options.
Nearly half of the interviewed physicians stated they were comfortable prescribing opioids, with the other half reporting “varying levels of comfort,” according to the researchers.
“Opioids are inexpensive and they’re effective. They work, which is why so many physicians still prescribe them. But what we have to realize is most of the prescriptions that we’re giving are overkill,” Dasa said. “We don’t need to be prescribing as many opiates as we’re doing. We’re overdoing it. Once we figure that out, then the next step is moving to the next level, which is opioid-free surgery, and what are the strategies to get us there?”
In the study, physicians commended opioids’ analgesic effectiveness but reported challenges associated with adverse events, addiction risk and the complexity of prescribing opioids to at-risk populations. More than half of the interviewees cited burdensome administrative barriers related to prescribing opioids, including quantity limits, state monitoring programs, stock shortages or pharmacist hesitancy to fill opioid prescriptions, and oversight by the Drug Enforcement Administration. Alternative treatments were also included in the questions, with surgeons describing the value of nonsteroidal anti-inflammatory drugs in reducing patients’ pain without the risk for addiction. However, they noted concerns of gastric bleeding, renal failure and an overall milder analgesic effectiveness compared with other pain medications. The effects on liver functioning and sedation, or altered cognition, of acetaminophen and gabapentin also raised concerns.
Half of the interviewed surgeons perceived their patients as only being “somewhat satisfied” with current pain medications, whereas two-thirds reported that patients had discontinued or were hesitant to begin pain treatment out of concerns for adverse events.
“Most surgeons feel that opioids are not the best option for our patients, and we need to come up with better alternatives beyond simply using opiates,” Dasa concluded. “They also voiced their frustration with the regulations that are being imposed in various states around the country. The issues around some of the side effects, such as nausea and constipation, obviously addiction independence, are big ones, and so this research [really highlighted] the shortcomings of our current pain management strategies.”
—Landon Gray
Dasa is an advisor for Vertex.
