PAIN MANAGEMENT

Chronic use of opioids among obese patients prior to bariatric suigery continues after suigery, and a recent study published in the Journal of the American Medical Association showed that postoperative doses have been greater than preoperative doses.

Marsha A. Raebel, PharmD, senior investigator at the Kaiser Permanente Colorado Institute for Health Research, Denver, and colleagues examined the electronic medical records and other clinical and administrative databases of 11,719 obese patients, 21 years of age and older, who underwent bariatric surgery between 2005 and 2009 at one of 10 U.S. sites in the Scalable Partnering Network. Participating patients were evaluated one year before and one year after surgery.

Chronic opioid use was defined as having 10 or more prescriptions over 90 days or more, or at least a 120-day total supply of medication sometime in the year prior to surgery. Some opioid use was defined as one to nine prescriptions over 90 days or less than a 120-day supply.

Findings

The researchers found that in the year prior to their surgical procedures, 56% of the patients in the study reported no opioid use for pain management, 36% used some opioids, and 8% used opioids on a chronic basis. Of the obese patients who exhibited chronic opioid use prior to suigery, 77% continued to use these medications chronically one year after their procedures. Chronic opioid use among these patients also increased by 13% the first year after surgery. "Despite a lack of evidence supporting longterm effectiveness of opioids for chronic noncancer pain, longterm opioid use has increased recently," Dr. …