Patients Underusing Non-Opioid Pain Relievers

Johns Hopkins researchers have completed a prospective cohort study which shows that patients are underutilizing over-the-counter medications.

Their work, “Opioid Oversupply After Joint and Spine Surgery: A Prospective Cohort Study,” appears in the April 17, 2018 edition of Anesthesia & Analgesia.

The authors set out to determine if patients are using non-opioid pain medications in addition to their prescribed opioids. The team recruited a large number of inpatient adult spine and joint surgery patients at The Johns Hopkins Hospital from August to November 2016.

Mark Bicket, M.D., assistant professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine and the paper’s first author, gathered data on substance abuse history, self-reported pain scores and preoperative opioids.

The study enrolled 140 patients (out of 141 eligible patients). Of that group, 35% had used preoperative opioids. Their average age was 56 years [standard deviation 16 years]. Forty seven percent of the study participants were women.

“One- and 6-month follow-up was achieved for 115 of the study enrollees (82%) and 110 enrollees (80%), respectively. Among patients who stopped opioid therapy, possession of unused opioids was reported by 73% (95% confidence intervals, 62%-82%) at 1-month follow-up and 34% (confidence interval, 24%-45%) at 6-month follow-up.”

“At 1 month, 46% had ≥20 unused pills, 37% had ≥200 morphine milligram equivalents, and only 6% reported using multiple non-opioid adjuncts. Many patients reported unsafe storage and failure to dispose of opioids at both 1-month (91% and 96%, respectively) and 6-month (92% and 47%, respectively) follow-up.”

Asked why people are not using more non-opioid pain relievers, Dr. Bicket told OTW, “Many people are not aware of how well some over-the-counter medications relieve pain. Compared to prescription opioids, pain relievers like ibuprofen relieve pain just as well or better than opioids, and with fewer side effects. Adding acetaminophen (Tylenol) to the mix provides an extra boost in pain relief greater than each drug by itself. Despite being available over-the-counter, these drugs often receive less attention that prescription opioids.”

As for how orthopedic surgeons might counsel their patients, Dr. Bicket commented: “First, they can provide patients with prescription strength non-opioid medications. Many patients place less value on a recommendation to take an over-the-counter drug than one that is prescribed by the surgeon. Second, they should reinforce the role of non-opioids as first line pain relief. Patients should rely on acetaminophen and ibuprofen as the primary pain relievers after surgery. Third, patients should take the two drugs in combination on a scheduled basis. That means telling patients to take ibuprofen and acetaminophen around the clock in the first few days after surgery.”