In a new study, researchers found that depression and anxiety in patients linked to more opioid use after surgery.
The finding could help doctors mitigate that risk by identifying which patients are more likely to continue to use opioids after their immediate recovery period.
The research was conducted by a team from Michigan Medicine.
Surgeons wielding their life-saving scalpels, laparoscopic tools, or other implements to repair or remove what ails their patients understand all too well that pain is an unavoidable part of the healing process.
Yet the current opioid crisis has made the standard prescribing practices for these highly effective analgesics fraught with risk.
Currently, there is not much research on which surgical patients require more or fewer opioids, despite a push in the field for personalized medicine.
In the study, the team looked at data for more than 1,000 people undergoing an elective hysterectomy, thoracic surgery, or a total knee or hip replacement.
Before their procedures, each patient provided demographic information and filled out several screening questionnaires.
They were given scores measuring their degree of depression, anxiety, fatigue, sleep disturbance, physical function, as well as the severity of their overall and surgical site pain.
The research team also measured how many pills were prescribed per patient. Each patient was then contacted one month following surgery to assess how many opioid pills they had consumed.
They found that anxiety is linked with more opioid use, which is disheartening to see but also heartening in the sense that this is something doctors could help to manage.
Other patient factors linked to increased opioid use included younger age, non-white race, no college degree, alcohol, and tobacco use, and sleep disturbance.
The team says people may be knowingly or unknowingly medicating for other conditions.
For example, patients with high anxiety around the time of surgery could be offered behavioral care or other non-opioid medications for anxiety and resulting pain.
This study also found overprescription of opioids for all surgical procedures and a correlation between the prescription size and use.
The team says that right-sizing prescriptions through initiatives such as the Michigan Opioid Prescribing Engagement Network (OPEN), which provides recommendations for prescription amounts for various medical procedures, is a critical first step.
But this step should be followed by more research into specific patient factors that can be addressed in other ways.
The lead author of the study is Daniel Larach, M.D., M.T.R., M.A., a resident at U-M.
The study is published in the Annals of Surgery.
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