Surprising Finding: Study Shows Surgery Reduces Chronic Opioid Use – Pain Medicine News – by Michael Vlessides – May 2020
Among chronic opioid users, having surgery seems to be associated with a faster time to opioid discontinuation—contrary to popular belief.
I’m very curious about what they consider “contrary to popular belief”. It doesn’t make much sense to believe that having surgery leads to a “longer time to opioid discontinuation.”
“Of patients coming to our operating rooms, 23% will already be on an opioid by the time they see you on the day of surgery, and 3% will be chronic opioid users,” said Naheed Jivraj, MD.
Though few articles mention it, opioids are deployed to combat pain, and having pain is precisely why these folks need surgery.
“Second, it’s unclear whether there are any risk factors associated with prolonged or continued opioid use in this population.”
Of note, the study found that a greater proportion of patients discontinued opioids in the year after surgery than their counterparts who did not have surgery (36% vs. 29%; P≤0.001).
I’m astonished that there’s only a 7% difference. If pain is resolved by surgery opioids would no longer be necessary, but we’ve learned that surgery can serve to aggravate a pain problem or incite another one instead of solving it.
The Pendulum Has Swung
Yet as Gregory Hare, MD, PhD, a professor of anesthesia at the University of Toronto, was quick to point out, discontinuing opioids may not necessarily be the holy grail that many clinicians think.
I congratulate Dr. Hare for his wisdom and ability to see through the smokescreen of the CDC’s guidelines, which have been interpreted to mean basically that opioids are dangerous and must be reduced or even stopped, even if they are effective and causing no problems for the patient.
“Is discontinuation of chronic opioids a good thing or a bad thing?” asked Dr. Hare, who was not involved in the study. “You may have people who are taking a Tylenol 3 [codeine-acetaminophen, Janssen] and they’re shopping, doing activities and seeing their friends, and I don’t think that’s a problem.’
“So I think these are important data, but it’s important to know who’s being harmed by being a chronic opioid user and who’s actually being helped, because I think the pendulum has swung way too far to one side,” Dr. Hare said.
This is exactly the issue: opioids themselves aren’t bad or good, but how people use them can be.
“I agree with you in terms of the pendulum being swung too far in the other direction,” Dr. Jivraj replied. “We’re seeing that already. For example, we’ve seen that chronic opioid users whose medications have been discontinued will subsequently go to other sources, whether it’s on the street or otherwise, and it’s caused an increase in opioid-related mortality.”
And here Dr. Jivraj is spouting the usual anti-opioid PROPaganda because he’s only thinking of addiction treatment, not pain treatment.
Repeatedly and without questioning their extreme bias, the media has supported PROP in associating all opioids with addiction and views the issue of chronic pain as mainly a psychological problem if it acknowledges pain at all.