Planning for surgery involves many considerations, including how pain will be managed afterward. Understanding the risks associated with opioid use after surgery is essential to avoid long-term dependence. Open discussions with a surgeon before an operation can help patients navigate pain relief options effectively.
Certain types of procedures carry a higher risk of prolonged opioid use, a phenomenon known as “new persistent opioid use” (NPOU). This condition occurs when a patient continues filling opioid prescriptions for months after surgery. Procedures involving the spine, head, or neck are among those most likely to lead to this complication. Other high-risk surgeries include knee replacement and the partial or complete removal of the colon.
Pain relief is a critical part of recovery following surgery. For individuals concerned about opioid use, discussing pain management strategies with a surgeon before the procedure can be beneficial. While opioids are effective for controlling acute post-surgical pain, their long-term use can pose significant risks.
A recent study found that even in countries with stricter opioid prescribing regulations, such as Austria, surgical patients remain vulnerable to NPOU. The findings highlight that while health care system factors influence opioid use, a patient’s history also plays a key role. Individuals with previous opioid exposure are more likely to continue using them after surgery compared to those who have never taken them before, often referred to as “opioid naïve” patients.
NPOU is categorized as a complication of surgery rather than outright addiction or misuse. In the study, it was defined as filling at least one opioid prescription within 90 days after surgery, followed by an additional prescription within 90 to 180 days. Various opioids were included in the study, such as buprenorphine, fentanyl, oxycodone, tramadol, and methadone.
The research analyzed data from over 550,000 individuals who underwent different types of surgery between 2016 and 2021. The surgeries included abdominal wall hernia repair, appendectomy, cholecystectomy, colectomy, mastectomy, prostatectomy, thyroidectomy, laryngeal surgery, hysterectomy, spine surgery, coronary artery bypass graft, and knee or hip replacement. Among all patients, 1.7% developed NPOU. Those who had spinal surgery had the highest rate, at 6.8%.
Studies conducted in the U.S. have reported even higher NPOU rates, with some findings suggesting that up to 7% of surgical patients continue using opioids post-recovery. Research has also shown that one in five individuals who undergo total hip or knee replacement rely on opioids for more than three months following surgery.
However, avoiding opioids entirely is not the solution. Effective pain management is crucial in the healing process. Poorly managed pain can interfere with recovery and may even lead to chronic pain.
Patients who experience persistent pain after surgery should communicate with their medical team to reassess their pain management plan. Consulting with a surgical team can help determine the appropriate next steps, ensuring pain relief while reducing the risk of long-term opioid dependence.
