A new study led by a McGill University scientist suggests that opioid pain relievers are not always helpful — and sometimes harmful — while patients are recovering from minor surgery.
The research, published in The Lancet, examined the results of 47 randomized clinical trials in patients discharged after a minor or moderate procedure ranging from molar extraction to foot surgery.
Dr. Julio Fiore, an assistant professor at McGill who studies postoperative recovery, said his team found that prescription opioids had no more effect on pain experienced after minor surgery than over-the-counter pain relievers.
At the same time, the study found a significant increase in side effects, including nausea, vomiting and constipation.
Fiore said the findings suggest that avoiding the prescription of opioid pain relievers can in many cases improve patients’ recovery experiences while helping to mitigate the well-documented dangers of opiate addiction.
Dr. Julio Fiore, an assistant professor at McGill who studies post-surgical recovery, led research suggesting that prescription opioids have no greater effect on pain experienced after minor surgery than over-the-counter pain relievers. (McGill University)
“We really expect these findings to encourage changes in prescribing practices,” Fiore said in an interview.
“After all, like opioid prescribing and post-discharge, our research shows that it doesn’t seem to be as beneficial to patients as previously thought.”
Fiore said more research is needed involving opioid prescribing after major surgery to determine best practices.
Of the studies reviewed, 30 involved minor procedures (most of which were dental), and 17 involved procedures of a more moderate nature, such as on the shoulder or leg.
Among the opioids most commonly prescribed by surgeons are oxycodone, hydromorphone, tramadol and codeine, according to the researchers.
Prescription opioids vary by state
Prescription of opioid painkillers varies widely between countries, and studies show that Canadian doctors still prescribe more opioids than their counterparts in Europe, but not as much as doctors in the United States.
one 2019 survey study of postoperative prescriptions found that almost half of US patients received prescriptions for high-dose opioids after certain surgeries, nearly twice as high as Canada and nine times as high as Sweden.
Dr. David Yurlink, head of clinical pharmacology at Sunnybrook Health Sciences Center in Toronto, who was not involved in the study, said many doctors and dentists in Canada still put opioid pain relievers on a “pedestal.”
He said the study was based on previous research and his own experience as a medical practitioner.
“The key message is that these drugs are still valuable. They’re certainly valuable in hospitals,” Jurlink said, but then added that doctors and dentists need to “keep in mind the fact that these drugs don’t work as well as we’ve been taught and they’re not as safe as we’ve been told. studied. And very often patients can do well without it.”
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Last week, the Ottawa and provincial governments reached a $150 million settlement with Purdue Pharma Canada to reimburse health care costs associated with the sale and marketing of opioid-based pain medications.
Officials say Purdue Pharma, the maker of OxyContin, downplayed the risks of its drugs when it marketed them to doctors, particularly their potential for addiction, contributing to the opioid crisis.
There are guidelines
Dr. Hans Clark, an anesthesiologist and medical director of the Pain Research Unit at Toronto General Hospital, also welcomed the findings. But he stressed that doctors are now better equipped than they were a decade ago to determine when to prescribe opioids.
In 2020, he helped develop guidelines for physicians which was intended to reduce the amount of prescription opioids so that fewer unused pills are available to those without a prescription.
Dr. Hans Clark is the Medical Director of the Pain Research Unit at Toronto General Hospital. He said prescription opioids can play an important role in patient recovery and pain management. (University Health Network)
Clark said opioid pain relievers can still play an important role in patient recovery and pain management for some patients, especially after major surgery.
He also cautioned against making a direct connection between prescribing opioid pain relievers and overdose crisis is now unfolding in many Canadian communities, which experts say is now being driven by the toxic supply of illegal drugs.
“I think we realized that the opioid crisis was not a consequence of our perioperative opioid prescribing, but we certainly could have done better,” said Clark, who was not involved in the study.
“One of the things we can do is figure out which types of surgery might need the right amount of opioids and which ones might not.” And the paper is pretty clear that when you’re dealing with fairly minor surgeries, opioids may not be necessary at all.”
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