Aug. 20 (UPI) -- Complex surgical patients safely and successfully tapered off opioids while coping with pain, according to a study.
Almost half of patients who did not take opioids before surgery weaned off opioids and 25 percent who took the drugs before surgery were able to get off them completely in the program at the Toronto General Hospital and University Health Network. The results of the study were published Monday in the Canadian Journal of Pain.
"The assumption is that all patients after surgery are fine with their opioid use, but we have found that in a high-risk segment of patients, that is not the case," Dr. Hance Clarke, director of the Transitional Pain Service at the hospital, said in a press release. "We need better ways of identifying these patients, and then helping those who are having difficulty in reducing or eliminating their opioid use. Otherwise, we run the risk of de-escalating patients too fast and having them look elsewhere for opioids or other drugs if we don't guide them."
Prescription opioids are the best pharmacological option available for acute chronic and cancer-related pain, but they often lead to addiction. In Canada, the Health Quality Ontario and the Canadian Pain Society created guidelines that opioids should not be considered the first line of defense in non-cancer pain.
In a 2016 study on the Transitional Pain Program at the hospital, an estimated 15 percent of complex postoperative pain patients develop moderate to severe chronic, post-surgical pain, have significant disability and use opioids for pain relief long-term.
"We need to give patients the tools to manage their pain," Clarke said. "Our clinical work and research suggests there is a powerful role for interventions other than opioids in helping patients manage their pain and suffering, taper their opioids and lead rich, meaningful lives. Our program is a good blueprint that we can use not only for surgical patients, but for anyone else dealing with an opioid addiction."
From May 2014 to July 2016, the study followed for six months 251 surgical patients at Toronto General Hospital at least 18 years old at risk of developing chronic pain or persistent opioid use,
The study found found 69 percent were able to reduce their opioid consumption and 45 percent stopped completely utilizing the program. Among those taking a prescription opioid before surgery, they reduced their opioid use by 44 per cent, including 26 percent completely.
The Transitional Pain Program included prescribing non-opioid medications, psychological techniques, such as mindfulness or moment-by-moment awareness of our thoughts and sensations, as well as "exercise prescriptions" and acupuncture. In addition, patients and primary care physicians receive support.
The program benefited Sheldon Fine, 67, who is a medical oncologist in Ontario.
After thoracic surgery to remove a huge benign mass on his right lung in 2017, he was on a daily dose of 120 milligrams of hydromorphone that is five times more powerful than morphine.
Utilizing the program, he cut the usage to 5 milligrams a day within five weeks and eventually off all dosage.
"It was team work," said Fine, who runs marathon and is back working full time. "The program involves patients every step of the way and sets milestones with them. They use different techniques such as physiotherapy and mindfulness training and the staff are so responsive to a patient's concerns and questions."
Researchers found the higher the dose, the more likely the patient will remain on opioids long-term.
In a Health Quality Ontario Report this year, surgeons in Ontario prescribed "new starts" of opioids to 265,643 patients in one year, and that 8 percent were above 90 mg of morphine equivalent.
Higher than 90 mg has been associated with an increase risk of death from opioid poisoning, according to the report.
"For a sub-population of patients who struggle with pain disability after surgery, it is important that we support them with appropriate pharmacological and non-pharmacological strategies," Clarke said.