Pain care for patients already taking opioids can be improved by bringing together multiple non-opioid treatment strategies during hospitalization, a new study has found.
Patients treated in this manner were less likely to be readmitted to the hospital within 60 days, according to the study's results, which were reported at the 32nd Annual Meeting of the American Academy of Pain Medicine.
A chief concern of the researchers was the high hospital readmission rates historically seen in opioid-tolerant patients due to continued pain symptoms. Opioid-tolerant patients who arrive for surgeries or procedures are at heightened risk of suffering acute pain and are in particular need of an alternative treatment plan, said the study's lead author, Dr. David Edwards, clinical chief of pain at Vanderbilt University Medical Center in Nashville, Tenn.
"The transition from in-hospital to out-of-hospital is where the problem lies," said Edwards in a statement. "Clinicians need to know what they can offer patients other than opioids to treat pain and suffering, especially when the patients arrive on high-dose opioids already."
Results showed that, as the use of diverse analgesic approaches grew, readmission rate, length of stay and opioid dose dropped. The return rate was 28 percent for the 18 opioid-tolerant patients who received such care compared with 40 percent for usual care, representing a 30 percent effect size. No adverse events or change in patient satisfaction were reported.
Next, a randomized, controlled trial will be completed at the study's three medical centers: Vanderbilt University Medical Center, Massachusetts General Hospital and Brigham and Women's Hospital. The ultimate aim is to change the standard of care for treatment of this group of patients. That would include practitioner education in multi-pronged pain management strategies to prevent opioid escalation -- and to help patients taper off high-risk medications after surgery.
For many surgical and nonsurgical patients, opioids are still the best and most potent way to treat pain, he said. But evidence indicates that the rise of opioid use, particularly when used in isolation, does not correspond to better pain control or patient satisfaction; rather, it contributes to poor patient outcomes and what Edwards called "a societal burden" when patients are eventually discharged on higher-than-ever doses.
"Society suffers when patients suffer," said Edwards. "The cost of risk-managing prolonged opioid therapy for an ever-increasing pool of patients on opioids overextends the medical system."
"The day has come and gone where solely using opioids to manage pain in noncancer patients is considered appropriate care," said Edwards.