Short-Term Opioid Prescribing Should Be Tailored to Patient Needs
/By Crystal Lindell
A new study has found something that every pain patient already knows: Opioid prescriptions “should be tailored to address individual patients’ needs.”
The research findings, which were published in JAMA, looked at how well opioids worked for 1,708 patients with short-term acute pain from a wide variety of conditions; from dental procedures and knee replacements to low back pain and cesarean sections.
The findings debunk common myths that many patients quickly become dependent on opioids and are unable to regulate their opioid use.
Overall, most of the patients used opioids for only a short amount of time – about 7 days – and at low doses (10 MME). Only 10% of patients used opioids for 90 days or more, which is generally considered the threshold for acute pain becoming chronic.
Overall, opioids were effective at relieving pain, with patients reporting a 55% reduction in pain on average. The median time to pain resolution was 20 days, although patients with low back pain or recovering from surgery took longer than that.
Most patients continued to use non-opioid pain relievers such as acetaminophen or ibuprofen, and also used ice or heat as part of a “multimodal treatment” approach.
About two-thirds of patients had leftover opioids. Interestingly, they were often patients with the longest-lasting pain conditions, which suggests they chose “not to continue using the opioids they had available” even when their pain persisted.
Current guidelines from the CDC and FDA for acute pain recommend opioids only for severe pain or when non-opioid pain medications are ineffective.
Given the wide variety in outcomes and patient preferences, researchers say their findings demonstrate that guidelines for short-term opioids should be tailored to each patient. Most patients in the study were pretty good about moderating their opioid use.
“Patients generally reported taking opioids on their worst pain days, in small amounts, for short periods, and in combination with other pharmacologic and nonpharmacologic treatments, with many patients limiting their opioid use to less than the amount prescribed by their clinician,” wrote lead author Molly Moore Jeffery, PhD, of the Mayo Clinic.
“The findings suggest current guidelines for multimodal treatment and short-duration opioid prescriptions, if needed, will serve many patients but not all and that treatment should be tailored to address individual patients’ needs.”
A recent study found that opioids are effective for many acute pain conditions and come with little risk. In a review of 59 clinical studies, researchers at the University of Sydney found that opioids were effective for “the vast majority of acute pain conditions,” with no significant risk of serious adverse events.
