Effective Physician Guidance Can Minimize Opioid Use Post-Surgery

Recent clinical trial findings indicate that preoperative counseling by healthcare providers can significantly decrease the dependence on opioid painkillers after orthopedic procedures. Specifically, patients undergoing knee surgeries such as anterior cruciate ligament (ACL) reconstruction were instructed to reserve opioids as a 'last resort' for managing unmanageable pain, rather than as a routine part of pain management.

In the study, conducted at the University of Maryland Rehabilitation & Orthopedic Institute, 121 patients were split into two groups: one received standard pain management advice, encouraging patients to take opioids as needed to 'stay ahead of pain,' while the other was counseled to consider opioids only if pain reached unbearable levels.

Results revealed that the 'last resort' group used markedly less oxycodone—averaging 15 mg compared to 53 mg in the standard group—over a three-month period. Additionally, about one-third of these patients did not require any opioids at all post-surgery. Importantly, their reported pain levels—measured on a scale from 0 to 10—were comparable to those who took opioids more liberally, averaging around 2.5 versus 2.4.

Those advised to limit opioid use experienced fewer adverse effects like nausea, constipation, and drowsiness. Dr. R. Frank Henn III highlighted that this approach not only reduces opioid consumption but also minimizes side effects without compromising pain relief.

The implications of this research are significant given the ongoing opioid crisis, which has led to over 800,000 deaths in the U.S. from 1999 to 2023 due to overdoses. Overprescribing of opioids after surgery has contributed to this epidemic, prompting medical professionals to explore new strategies for pain management.

The study focused on ACL reconstruction patients, a common surgical procedure often associated with opioid prescription. Results showed that patients counseled to use opioids sparingly had substantially lower opioid intake and fewer refills, with no difference in pain control or patient satisfaction.

Lead researcher Dr. Jonathan Packer emphasized that instructing patients to use opioids only as a last resort can be an effective and safe method to manage postoperative pain. He advocates for adopting this simple yet impactful approach across surgical disciplines to promote safer pain management practices.

This evidence supports revising traditional pain management guidelines, moving away from the practice of preemptive opioid use. Instead, tailored counseling and conservative opioid use can play a crucial role in combating the opioid epidemic while still effectively managing patients' pain.