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Bariatric surgery may cause opioid use to increase in some

Friday October 4, 2013
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In a group of patients who chronically used opioids for noncancer pain and who underwent bariatric surgery, there was greater chronic use of opioids after surgery compared with before, according to a study.

The findings suggest the need for proactive management of chronic pain in these patients after surgery, researchers reported in the Oct. 2 issue of the Journal of the American Medical Association.

Marsha A. Raebel, PharmD, of Kaiser Permanente Colorado, Denver, and colleagues conducted a study to examine opioid use following bariatric surgery in patients using opioids chronically for pain control before their surgery. The study included 11,719 individuals ages 21 and older who had bariatric surgery between 2005 and 2009 and who were assessed one year before and after surgery, with latest follow-up by December 2010.

In the year before bariatric surgery, 56% of the patients had no opioid use, 36% had some opioid use and 8% had chronic opioid use. Among pre-surgery chronic users, 77% continued chronic opioid use after surgery. Relative to the year before surgery, the amount of opioid use by patients who were chronic opioid users before surgery increased by 13% the first year after surgery and by 18% across three post-surgery years.

For the group with chronic opiate use prior to surgery, change in morphine equivalents before versus after surgery did not differ between individuals who lost more than 50% of their excess body mass index and those who lost 50% or less.

Neither preoperative depression nor chronic pain diagnoses influenced changes in preoperative to postoperative chronic opioid use.

“We anticipated [that] weight loss after bariatric surgery would result in reduced pain and opioid use among patients with chronic pain,” the authors wrote. “However, patients with and without preoperative chronic pain, depression diagnoses or both had similar increases in postoperative chronic opioid use after surgery as those without chronic pain and depression. One possible explanation is that some patients likely had pain unresponsive to weight loss but potentially responsive to opioids.

“These findings suggest the need for better pain management in these patients following surgery.”

In an accompanying editorial, Daniel P. Alford, MD, MPH, of Boston Medical Center, discusses the importance of reducing or eliminating opioid use among patients when warranted:

“The safe and appropriate prescribing of opioids for chronic pain has become an important national priority. Although core competencies for pain management are being developed, knowing when and how to continue, change or discontinue opioid therapy must be included in all clinician education efforts.

“Although Raebel et al are correct in reporting that better pain management strategies are needed, they also may have uncovered an equally important problem: the need to know if, when and how to safely and effectively taper or discontinue opioid therapy for patients with chronic pain.”

Study abstract: http://jama.jamanetwork.com/article.aspx?articleid=1745677


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