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Treatment for addiction takes many forms and depends on the needs of the
individual. In accordance with the American Society of Addiction Medicine, we offer
information on outcome-oriented treatment that adheres to an established continuum of
care. In this section, you will find information and resources related to evidence-based
treatment models, counseling and therapy and payment and insurance options.
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A Stanford University School of Medicine study found treating pain with opioids after surgery increases the risk of long-term opioid use in patients with no prior use.
Researchers were looking to see if post-operation pain management with opioids, such as oxycodone or hydrocodone, is a risk factor for chronic use among patients who never took opioids or haven’t developed a tolerance to the drugs.
They classified chronic users as patients who filled at least 10 opioid prescriptions or exceeded a 120-day supply the first year after surgery. Results indicated a 0.5 percent increase in risk of chronic opioid use in most patients.
“Patients who didn’t use opioids prior to surgery were at an increased risk for chronic opioid use following their surgery,” lead author Dr. Eric Sun, an instructor in anesthesiology at Stanford, told CBS New York.
The study, published in JAMA Internal Medicine, evaluated the health insurance claims of nearly 642,000 surgical patients who had not filled an opioid prescription the year prior. Each underwent one of 11 common surgical procedures between Jan. 1, 2001, and Dec. 31, 2013.
Men, people aged 50 or older and those with a history of drug or alcohol abuse were at an increased risk of chronic use. Other risk factors included a history of depression and using benzodiazepines, a class of anti-anxiety medications.
Patients who underwent more painful surgeries, such as total knee arthroplasty and open cholecystectomy, showed the greatest risk for chronic use.
Researchers also found:
Knee surgery patients were five times as likely to become chronic opioid users compared to nonsurgical patients.
Gall bladder surgery increased the risk of chronic use by 3.5 times.
Women who underwent cesarean section surgery were 28 percent more likely than a control group to become long-term opioid users.
The overall risk of addiction was slight, and the results should not deter patients from surgery, the report concluded. Instead, researchers called upon physicians to closely monitor post-op prescription opioid use in their patients.
“The message isn’t that you shouldn’t have surgery,” Sun said in a Stanford Medicine press release. “Rather, there are things that anesthesiologists can do to reduce the risk by finding other ways of controlling the pain and using replacements for opioids when possible.”
Searching for Safer Medications
Many people who receive surgery later develop chronic pain, a widespread issue that affects 100 million Americans, per a 2011 report from the Institute of Medicine.
As a result, clinicians are searching for safer and equally effective alternatives to managing pain.
Researchers at Duke University in June developed a less toxic class of drugs that could replace opioids. The medications target TRPV4 and TRPA1, two central nervous system receptors that identify pain.
One of the drugs, 16-8, successfully treated abdominal aches and pancreas inflammation in mice. Researchers believe the medication could treat headaches, jaw pain, osteoarthritis and nerve cell injuries in humans.
This line of medicines could help reduce opioid abuse. However, further tests must be completed to confirm its validity.
Other Opioid Alternatives
James B. Ray, clinical pharmacy coordinator for pain and palliative care at the University of Virginia Health Center in Charlottesville, suggested combining drugs with differing mechanisms of action.
For example, acetaminophens, such as Tylenol, could be combined with nonsteroidal anti-inflammatory drugs, such as ibuprofen, to combat pain. The method is a less-toxic alternative, he told Medscape Medical News.
However, pain pills aren’t the only remedy.
Stanford researchers said comprehensive care that combines physical therapy, emotional support and education about coping skills could prove beneficial to patients. Comprehensive care techniques include diaphragmatic breathing, muscle relaxation and meditation.
Beth Darnall, clinical associate professor of anesthesiology at Stanford University, says techniques that calm the central nervous system could decrease post-surgical pain. This reduces the need for opioids and leads to a quicker recovery.
Medical Disclaimer: DrugRehab.com aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.
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The American Academy of Pain Medicine. (n.d.). AAPM Facts and Figures on Pain. Retrieved from http://www.painmed.org/patientcenter/facts_on_pain.aspx#chronic
CBS New York. (2016, July 11). Study: Risk For Opioid Abuse Increases Following Surgery. Retrieved from http://newyork.cbslocal.com/2016/07/11/opioids-and-surgery/
Haglage, A. (2016, June 1). These New Painkillers Could Replace Opioids. Retrieved from http://www.thedailybeast.com/articles/2016/06/01/these-new-painkillers-could-replace-opioids.html
Melville, N.A. (2013, September 20). Opioid Alternatives Urged Postoperatively Retrieved from http://www.medscape.com/viewarticle/811385
Sun, E.C. et al. (2016, July 11). Incidence of and Risk Factors for Chronic Opioid Use Among Opioid-Naive Patients in the Postoperative Period. Retrieved from http://archinte.jamanetwork.com/article.aspx?articleid=2532789
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