Opiod Use after Bariatric Surgery

 Marsha A. Raebel, PharmD, BCPS, FCCP Investigator in Pharmacotherapy Institute for Health Research 10065 E. Harvard Ave Suite 300 Denver, CO 80231.MedicalResearch.com Interview with:
Marsha A. Raebel, PharmD, BCPS, FCCP
Investigator in Pharmacotherapy
Institute for Health Research
10065 E. Harvard Ave Suite 300
Denver, CO 80231.


MedicalResearch.com: What are the main findings of the study?

Answer: We found that in a group of patients who took chronic opioids for non-cancer pain and who underwent bariatric surgery there was greater chronic use of opioids after surgery compared with before surgery, findings that suggest the need for proactive management of chronic pain in these patients after surgery.

Importantly:

  • The study included 11,719 individuals 21 years of age and older who had bariatric surgery between 2005 and 2009, and who were assessed 1 year before and after surgery.
  • In the year before bariatric surgery, 56 percent of patients had no opioid use, 36 percent had some opioid use, and 8 percent had chronic opioid use.
  • Among pre-surgery chronic users, 77 percent continued chronic opioid use after surgery.
  • The amount of opioid use by patients who were chronic opioid users before surgery increased by 13 percent the first year after surgery and by 18 percent across 3 post-surgery years.
  • For the group with chronic opiate use prior to surgery, the change in opioid use before vs. after surgery did not differ between individuals who lost more than 50 percent of their excess body mass index vs. those who lost 50 percent or less.
  • Neither preoperative depression nor chronic pain diagnoses influenced changes in preoperative to postoperative chronic opioid use.

There was little already known about this subject. Specifically, it was not known whether opioid use for chronic pain in obese individuals undergoing bariatric surgery was reduced. We found it was not reduced, but rather it increased in these individuals.

MedicalResearch.com:  Were any of the findings unexpected?

Answer: We anticipated that weight loss after bariatric surgery would result in reduced pain and opioid use among patients with chronic pain. However, patients with and without preoperative chronic pain, depression diagnoses, or both had similar increases in postoperative chronic opioid use after surgery, as did patients without chronic pain or depression. One possible explanation is that some patients likely had pain unresponsive to weight loss but potentially responsive to opioids. This suggests the need for better pain management in these patients following surgery.

There was little already known about this subject. Specifically, it was not known whether opioid use for chronic pain in obese individuals undergoing bariatric surgery was reduced. We found it was not reduced, but rather it increased in these individuals.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer: There are limited options for pain management available to bariatric surgery patients because non-steroidal, anti-inflammatory medications increase the risk of ulcers, particularly after bariatric surgery. While acetaminophen can be used, it is less effective. Clinicians need support to address if, when, and how to effectively and safely adjust or stop opioid therapy for patients with chronic pain. Given the increasing chronic usage rate reported in this study, it’s clear that the medical community needs to develop better pain management programs for patients who use opioids long-term following bariatric surgery.

Specifically, if opioids are to be used chronically, it should be with a treatment plan in place that has been agreed-upon by the physician and patient and is monitored routinely. Also, as some patients may seek bariatric surgery with the expectation that they will have less pain after the surgery, physicians should counsel their bariatric surgery patients that bariatric surgery may not reduce their pain.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Answer: We intend to continue studying opioid use in the bariatric surgery population to gain a better understanding of the risks and benefits. Our future work is intended to aid in developing strategies to improve pain management among this patient population.

Citation:

Raebel MA, Newcomer SR, Reifler LM, et al. Chronic Use of Opioid Medications Before and After Bariatric Surgery. JAMA. 2013;310(13):1369-1376. doi:10.1001/jama.2013.278344.

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