Determining the Right Opioid Dose and Duration for Post-Operative Pain Management

MedAware recently hosted a webinar with opioid addiction specialist, Dr. Edwin Salsitz, in which he provided an in-depth look at the evolution of the opioid crisis, patterns that have emerged, and how different measures to combat misuse have come into play. By leveraging numerous studies and data points, and layering on personal experience, Dr. Salsitz was able to provide a look into the opioid epidemic that was both insightful and alarming.

Throughout it all, one question still remains top of mind: When prescribing opioids for pain management after surgery, what is the appropriate dose and timing regimen to alleviate pain while minimizing the risk of dependency?

According to Dr. Salsitz, this question alone is entirely too broad to accurately answer since there are many variables that come into play, including:

• Type of surgery
  Some surgeries result in more post-op pain than others. Laparoscopic surgeries, for example, may only need minimal pain management.
• Pain tolerance of the patient
  If a patient tolerates pain well, a lower dose and shorter duration may be all that’s needed.
• Opioid tolerance of the patient
  The unwanted side effects of opioids (nausea, drowsiness, constipation, etc) may be too much for some patients, who may prefer no or low-dose opioid options.
• Patient history/risk of becoming dependent
  Patients with a history of opioid misuse or those taking medications that interact with opioids may need to avoid or minimize opioid therapy post-operatively.
• Effectiveness of alternative therapies
  Depending on the level of pain, alternative therapies such as NSAIDs, heating/cooling pads, and acupuncture may be just as effective. 

Dr. Salsitz also points out that successfully managing pain doesn’t necessarily mean completely eliminating a patient’s pain, taking it from a 10 to a 0 on the pain scale. Rather, the focus should be on reducing it from a 10 to perhaps a 3 or 4, or whatever level is tolerable by the patient and minimally impactful in their daily life. When prescribing an opioid, the goal should be the lowest dose possible to make the patient comfortable, with opioid therapy reduced or discontinued as soon as feasible after the operation.

For all these reasons, no two patient cases are the same and a one size fits all approach to pain management simply doesn’t work. The full patient profile and context of the situation must be evaluated, and any opioid therapy started should be continually monitored for appropriateness.

When reviewing all the tools and technologies available to manage and monitor opioid use, however, few are able to accurately assess the patient profile at the time of the first prescription to determine the risk of a patient becoming dependent. Adding MedAware’s medication safety monitoring platform to the mix provides an additional safety net for providers and patients from the point of prescribing throughout the entire course of treatment.  

Additional reading you may be interested in:

• A Road Paved With Good Intentions: Looking Back At The Opioid Epidemic And Finding A Path Forward
• Identifying Future Opioid Dependency Risk At The Point Of Prescribing
• Identifying Patients With Undiagnosed Opioid Use Disorder