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Presenter: Re-evaluate the use of opioids
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DALLAS — Orthopedic surgeons should think carefully before prescribing opioids to patients for postoperative total joint arthroplasty pain, according to a speaker here.
“If I could have you take one single message, it is that you look carefully at the way we are prescribing opioids and look at the guidelines and reconsider where opioids fit in that role,” Eugene R. Viscusi, MD, said at the American Association of Hip and Knee Surgeons Annual Meeting. “In the last year, the CDC and FDA have come out with two important statements that approach this opioid epidemic crisis that we have.”
According to the CDC guideline for prescribing opioids for chronic pain, the CDC recommends for patients to use immediate-release opioids by starting low and going slow; prescribe no more than needed when opioids are needed for acute pain; not to use extended release and long-acting opioids for acute pain; to follow-up and re-evaluate risk of harm; and reduce dose or discontinue opioid use if needed.
In addition, the FDA released a warning about several safety issues with opioid pain medicines and required label changes, which included to prescribe non-opioids first; prescribe the smallest effective dose; avoid long-acting or extending release; have an exit strategy at initiation; and prescribe opioids for moderate to severe pain after other analgesics have failed.
“Even though these [guidelines] are targeted at primary care physicians, these are well-worth reading because you will deal with pain with your joint patients either preoperatively or postoperatively, and we have made a mess of the way we use opioids,” Viscusi said. “In acute pain, short-acting opioids have a significant risk of abuse, addiction, overdose and death.”
According to Viscusi, there is no evidence that shows long-acting opioids improve pain control, and the relative risk of a respiratory death is much higher anytime an opioid is delivered continuously.
“Never in [an] acute pain setting should you initiate a long-acting opioid,” he said. – by Nhu Te
Reference:
Viscusi ER. Postop total joint arthroplasty pain and top five management tools. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 10-13, 2016; Dallas.
Disclosure: Viscusi reports he receives research grants from Durect and Pacira, and is a consultant for AcelRx, Cara, Astra Zeneca, Mallinckrodt, the Medicines Company, Heron, Merck, Pacira, Salix and Trevana.