Pain scores, age can help identify patients more likely to use few or no opioids after surgery

A Penn Medicine study shows that patient pain scores are a good predictor for opioid use, but younger patients and those who hadn’t used opioids before are less likely to take them.

Patients who are younger or who haven’t taken opioid pain medication before are more likely to not need any after many common surgeries, according to new research from the Perelman School of Medicine. Additionally, the study, published in Annals of Surgery Open, shows that simply understanding a patient’s history with opioids and how they are feeling upon leaving the hospital could help clinicians tailor the amount of prescription pain medicines they may need as they transition home.

An open prescription bottle of opioids.
Image: iStock/Charles Wollertz

“At face value, it seems quite simple that asking patients about their pain and use of pain medicine would help inform what we do, but it is often easy to lose sight of the value of these patient-informed moments,” says first author Anish Agarwal, an assistant professor of emergency medicine and the deputy director of the Penn Medicine Center for Insights to Outcomes. “These are simple data points, but they could be used in a high impact way to help manage pain, tailor prescribing, and support clinicians who are trying to better balance the risks of opioids while addressing expected pain following surgery.”

The study, co-led by Kit Delgado, an associate professor of emergency medicine and epidemiology, director of the Penn Medicine Nudge Unit, and co-chair of the Penn Medicine Opioid Task Force, used data collected through automated text messages sent to approximately 3,600 patients who had one of the 30 most common surgical procedures at the University of Pennsylvania Health System. Mostly, these surgeries fell under the umbrella of orthopaedic (such as hip or knee procedures) or neurosurgery (spine or back procedures).

Among the questions surgery patients were asked via text message were whether they filled their opioid prescription, their pain level on a scale of one to 10, how well they felt they could manage the pain, and how many opioid tablets they actually used.

“Previously, our team had used this automated text messaging program to generate procedure-specific guidelines, and these guidelines recommended a default quantity that would cover most patient needs, though most would need less and some needed more,” Delgado says. “We wanted to use the data to identify some common factors that could guide clinicians to ‘right size’ prescriptions based on a patient’s personal characteristics.”

Overall, of patients who hadn’t taken opioids before (termed opioid naivety), more than half used either none or less than five of the opioid tablets they’d been prescribed. The researchers found that in hip replacements, patients who were opioid naïve and rated their pain low when being discharged used an average of about five opioid tablets, while patients who had used opioids before and rated their pain high at discharge used an average of 20 tablets.

Read more at Penn Medicine News.