Theoretical opioid addiction affects pain management choices after Mohs

Key takeaways:

• Most patients receiving Mohs micrographic surgery (MMS) said they would prefer over-the-counter pain medication.
• When addiction risk is low, more patients would consider the use of opioid medications after MMS.

The risk for theoretical opioid addiction affected some patients’ choice of pain medications after Mohs micrographic surgery, according to a study.

Approximately 26% of patients who underwent Mohs micrographic surgery (MMS) between January 2009 and June 2020 filled opioid prescriptions, with the percentage rising to 39.6% in 2011 and then decreasing steadily to 11.7% in 2020.

It is hypothesized that the increase in opioid addictions documented following the use of short-term opioids in other medical specialties could be responsible for the decrease in MMS patients, according to the study.

“Patient preferences for pain medications have been evaluated in other specialties, with discordance noted between physician prescribing and patient preferences,” Shannon T. Nugent, MD, of Sidney Kimmel Medical College at Thomas Jefferson University, and colleagues wrote. “The purpose of this study was to investigate patient preferences for pain medications after MMS using a discrete choice experiment (DCE).”

Researchers conducted a prospective survey administered to 295 patients who received MMS at one location between August 2021 and April 2022.

Twelve scenarios were presented with two hypothetical pain management choices in each: opioids plus over-the-counter medication or OTC only.

Varying addiction risk profiles were included in the scenarios.

Of the 295 who responded to the survey, 101 (34.2%) reported they would never consider the use of opioids regardless of pain level, whereas 147 (49.8%) said they would be concerned about possible opioid addiction.

A preference for only OTC was preferred by 224 (76%) of patients. When the risk for addiction was low approximately half of patients said they would prefer an opioid plus OTC medications if their pain level was above a 6.5 on a 10-point scale; however, as the risk for addiction increased, patients preferred only OTC medications.

“These findings may spur research investigating the risk of long-term opioid use after MMS and provide a framework for Mohs surgeons to engage in shared decision-making with patients moving forward,” the authors wrote.