Narcotic pain pills
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Narcotic Pain Pills: Usage, Overprescription, and Alternatives
Long-term Use of Narcotic Analgesics in Chronic Pain Management
Narcotic analgesics, also known as opioids, have traditionally been avoided in the treatment of chronic pain due to concerns about addiction, habituation, and the development of psychological and behavioral symptoms that are not responsive to narcotic medications. However, some studies suggest that low-dose narcotic analgesics can be a component of a comprehensive pain management program, maintaining efficacy over the long term and improving patient function without significant side effects.
Overprescription of Narcotics Post-Surgery
Total Knee Arthroplasty (TKA)
Research indicates that significantly more narcotics are prescribed than are actually consumed by patients following primary unilateral total knee arthroplasty (TKA). On average, patients were prescribed 105.1 narcotic pills but only took 52.0, resulting in an excess of 53.1 pills per patient. This overprescription highlights the need for adjusting prescribing patterns to better match actual patient usage, potentially reducing the number of excess narcotic pills.
Foot and Ankle Surgery
Similarly, in outpatient foot and ankle surgeries, patients consumed an average of 22.5 narcotic pills, despite being prescribed 40 to 60 pills. Pain scores decreased significantly over time, suggesting that a lower number of pills could be sufficient for effective pain management. The study recommends prescribing around 30 pills for such procedures.
Breast Surgery
In breast surgery, a review of narcotic-prescribing patterns revealed that most prescribed pills were not used. For example, patients undergoing excisional biopsy or lumpectomy used a median of only 1 pill, while those undergoing mastectomy with reconstruction used a median of 18 pills. This suggests that further reductions in narcotic prescriptions are feasible and could be implemented based on patient usage data.
Non-Narcotic Alternatives for Postoperative Pain
Kidney Stone Surgery
A randomized clinical trial comparing non-opioid therapy (Ketorolac) to opioid therapy (Acetaminophen/Oxycodone) after kidney stone surgery found that non-opioid analgesia was non-inferior to opioid analgesia in terms of pain outcomes. Patients in the non-opioid group reported significantly lower average pain scores and worst pain intensity levels, suggesting that non-opioid analgesics can be an effective option for pain management following noninvasive urologic procedures.
Robotic Urologic Surgery
In robotic urologic surgeries, such as radical prostatectomy and partial nephrectomy, a significant number of patients took few or no narcotic pills post-discharge. Factors such as lower postoperative pain scores and minimal in-hospital narcotic use were associated with reduced home narcotic use. This indicates that many patients may not need narcotic prescriptions for discharge, and clinicians should consider these parameters to limit the number of prescribed but unused pills.
Impact of Preoperative Education
Preoperative education on opioid use has been shown to significantly reduce narcotic consumption post-surgery. In patients undergoing arthroscopic rotator cuff repair, those who received preoperative education consumed fewer narcotics and were more likely to discontinue their use earlier compared to those who did not receive such education. This suggests that targeted patient education can play a crucial role in mitigating the opioid epidemic by reducing unnecessary narcotic use.
Conclusion
The overprescription of narcotic pain pills post-surgery is a significant issue, with many patients consuming far fewer pills than prescribed. Adjusting prescribing patterns based on actual patient usage, considering non-narcotic alternatives, and implementing preoperative education can help reduce the number of excess narcotic pills and address the ongoing opioid crisis. By optimizing pain management strategies, healthcare providers can ensure effective pain relief while minimizing the risks associated with narcotic analgesics.
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