OTC meds more effective for post-surgery pain than opioids

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There is more evidence that it is possible to treat post-surgery pain effectively using nonprescription medications instead of opioids, according to a recent study.

A study published in the Annals of Surgery by a team from Michigan Medicine, the University of Michigan’s academic medical center, looked at data from 22,000 individuals who had common surgeries across 70 different hospitals in 2019.

The study’s authors found that medications such as ibuprofen or acetaminophen could be used for post-surgery pain instead of opioids, and did not lead to higher pain levels, serious issues during recovery or patient dissatisfaction.

“This really builds on the foundation that we don’t always need to use opioids with post-surgical patients,” said Dr. Sterling Ransone, president-elect of the American Academy of Family Physicians.

Researchers analyzed 2019 data from a Michigan-based surgical care registry and found 86% of patients received an opioid prescription after a hernia, gallbladder, appendix, bowel, thyroid or gynecological operation, and 14% received non-opioid painkiller prescriptions. The researchers surveyed these patients about their experience after they had a chance to recover.

Around 82% of both groups said they were highly satisfied with their care and 93% said they had no regret about their surgery.

Twelve percent of both groups experienced an emergency department visit, readmission, or re-operation within the first month after their initial operation.

Those who received non-opioid analgesics were 5% more likely to report no pain during the first week after surgery than those who received opioids and slightly more likely to say they had the best possible quality of life after the surgery—66% for non-opioid vs 63% for opioid users.

Dr. Jane Ballantyne, professor of anesthesiology, and pain medicine at the University of Washington and president of Physicians for Responsible Opioid Prescribing, said studies like these are important because they validate what clinicians have been saying for a while, that there is “pretty good pain relief” from mild analgesics like ibuprofen and acetaminophen.

Still, Ransone said it is good that people who do not receive opioids following surgery generally do not suffer, as there is a concern that patients given opioids could develop a tolerance and potentially become addicted to the drug later in their lives.

It’s, important for healthcare professionals to talk to patients about different options to manage their pain postoperatively, such as hypnosis, cardiac coherence or acupuncture, he said.

“We need to engage in shared decision making between the patient and the physician on how they would like to be treated,” Ransone said. “You need to explain to them how you can best treat their pain and explain that treating pain isn’t necessarily taking a pill.”

That doesn’t mean opioids post-surgery should be banned, since different procedures can cause different types of pain and individuals have various pain tolerance levels.

The Centers for Disease Control and Prevention suggests physicians prescribe non-opioid analgesics and non-pharmacologic therapies first post-surgery. If opioids are necessary, they should be prescribed at the lowest effective dosage for a short period of time.

All analgesics like Tylenol or Advil could cause gastric ulcers, kidney malfunction or blood platelets irregularities, but they don’t have the same addiction risks or other side effects, such as drowsiness.

“Nobody’s saying you should never use opiates for acute pain management,” Ballantyne said. “What they are saying is there are a lot of procedures that are associated with mild to moderate pain, where alternatives may actually be better.”

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