Variations in prescribing narcotics for pain seen among foot and ankle specialists

ORLANDO, Fla. — Results of a survey of 64 orthopedic surgeons presented here showed significant variability in how narcotics are prescribed for patients with foot and ankle pain. According to the researchers, these inconsistencies highlight the need for better, more clear-cut criteria on how to most efficiently use narcotics postoperatively.

Those surveyed, 39% of whom practiced in an academic setting, were presented with four clinical scenarios. They then answered multiple-choice questions regarding the type and dose of pain medication they would prescribe postoperatively for the different scenarios.

According to Thomas M. Hearty, MD, who presented the results at the American Academy of Orthopaedic Surgeons Annual Meeting, he and his colleagues saw variation in the postoperative pain management practices used.

“The research demonstrates that multimodal agents definitely increase the odds of abuse, and we asked about that. We saw that besides regional anesthetic, a lot of surgeons are not using multimodal agents in the immediate postop period, with the exception of NSAIDs,” Hearty said.

Sometimes, for the same clinical scenario presented, surgeons noted they prescribed 20 pills to 40 pills, while other surgeons prescribed as many as 80 pills, Hearty noted. The medications prescribed included hydrocodone, oxycodone and oxycontin, based on the survey results.

“Why is there so much variability in postoperative foot and ankle pain management? Do we understand? Are we trained to manage pain?” Hearty said, noting there are steps that can be taken to stop this problem while helping patients with their pain.

“The [American] Academy [of Orthopaedic Surgeons] has come out with some recommendations. These are vague and I think we need to elucidate these a little bit more, particularly expected ranges and amounts of medication, limited use of the extended release medications, limited use of products and tight communications, and periodic [continuing medical education] CME training, which I think would be effective,” Hearty said. – by Susan M. Rapp

Reference:

Hearty TM, et al. Paper #260. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 1-5, 2016; Orlando, Fla.

Disclosure: Hearty reports no relevant financial disclosures.