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Optimizing opioid prescribing and pain treatment for surgery: Review and conceptual framework.
Am J Health Syst Pharm. 2019 09 03; 76(18):1403-1412.AJ

Abstract

PURPOSE

Millions of Americans who undergo surgical procedures receive opioid prescriptions as they return home. While some derive great benefit from these medicines, others experience adverse events, convert to chronic opioid use, or have unused medicines that serve as a reservoir for potential nonmedical use. Our aim was to investigate concepts and methods relevant to optimal opioid prescribing and pain treatment in the perioperative period.

METHODS

We reviewed existing literature for trials on factors that influence opioid prescribing and optimization of pain treatment for surgical procedures and generated a conceptual framework to guide future quality, safety, and research efforts.

RESULTS

Opioid prescribing and pain treatment after discharge from surgery broadly consist of 3 key interacting perspectives, including those of the patient, the perioperative team, and, serving in an essential role for all patients, the pharmacist. Systems-based factors, ranging from the organizational environment's ability to provide multimodal analgesia and participation in enhanced recovery after surgery programs to other healthcare system and macro-level trends, shape these interactions and influence opioid-related safety outcomes.

CONCLUSIONS

The severity and persistence of the opioid crisis underscore the urgent need for interventions to improve postoperative prescription opioid use in the United States. Such interventions are likely to be most effective, with the fewest unintended consequences, if based on sound evidence and built on multidisciplinary efforts that include pharmacists, nurses, surgeons, anesthesiologists, and the patient. Future studies have the potential to identify the optimal amount to prescribe, improve patient-focused safety and quality outcomes, and help curb the oversupply of opioids that contributes to the most pressing public health crisis of our time.

Authors+Show Affiliations

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, and Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.Harvard Medical School, Boston, MA, and Division of Acute Care Surgery, Beth Israel Deaconess Medical Center, Boston, MA.Gastrointestinal Epidemiology Research Center, Department of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD.Department of Anesthesiology, Hospital for Special Surgery, and Department of Anesthesiology, Weill Cornell Medicine, New York, NY.Department of Pharmacy, Johns Hopkins Hospital, and Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital, Baltimore, MD.Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31505561

Citation

Bicket, Mark C., et al. "Optimizing Opioid Prescribing and Pain Treatment for Surgery: Review and Conceptual Framework." American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists, vol. 76, no. 18, 2019, pp. 1403-1412.
Bicket MC, Brat GA, Hutfless S, et al. Optimizing opioid prescribing and pain treatment for surgery: Review and conceptual framework. Am J Health Syst Pharm. 2019;76(18):1403-1412.
Bicket, M. C., Brat, G. A., Hutfless, S., Wu, C. L., Nesbit, S. A., & Alexander, G. C. (2019). Optimizing opioid prescribing and pain treatment for surgery: Review and conceptual framework. American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists, 76(18), 1403-1412. https://doi.org/10.1093/ajhp/zxz146
Bicket MC, et al. Optimizing Opioid Prescribing and Pain Treatment for Surgery: Review and Conceptual Framework. Am J Health Syst Pharm. 2019 09 3;76(18):1403-1412. PubMed PMID: 31505561.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Optimizing opioid prescribing and pain treatment for surgery: Review and conceptual framework. AU - Bicket,Mark C, AU - Brat,Gabriel A, AU - Hutfless,Susan, AU - Wu,Christopher L, AU - Nesbit,Suzanne A, AU - Alexander,G Caleb, PY - 2019/9/11/entrez PY - 2019/9/11/pubmed PY - 2020/2/11/medline KW - nonopioid analgesics KW - nonpharmacologic pain treatment KW - opioid analgesics KW - perioperative team KW - postsurgical pain SP - 1403 EP - 1412 JF - American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists JO - Am J Health Syst Pharm VL - 76 IS - 18 N2 - PURPOSE: Millions of Americans who undergo surgical procedures receive opioid prescriptions as they return home. While some derive great benefit from these medicines, others experience adverse events, convert to chronic opioid use, or have unused medicines that serve as a reservoir for potential nonmedical use. Our aim was to investigate concepts and methods relevant to optimal opioid prescribing and pain treatment in the perioperative period. METHODS: We reviewed existing literature for trials on factors that influence opioid prescribing and optimization of pain treatment for surgical procedures and generated a conceptual framework to guide future quality, safety, and research efforts. RESULTS: Opioid prescribing and pain treatment after discharge from surgery broadly consist of 3 key interacting perspectives, including those of the patient, the perioperative team, and, serving in an essential role for all patients, the pharmacist. Systems-based factors, ranging from the organizational environment's ability to provide multimodal analgesia and participation in enhanced recovery after surgery programs to other healthcare system and macro-level trends, shape these interactions and influence opioid-related safety outcomes. CONCLUSIONS: The severity and persistence of the opioid crisis underscore the urgent need for interventions to improve postoperative prescription opioid use in the United States. Such interventions are likely to be most effective, with the fewest unintended consequences, if based on sound evidence and built on multidisciplinary efforts that include pharmacists, nurses, surgeons, anesthesiologists, and the patient. Future studies have the potential to identify the optimal amount to prescribe, improve patient-focused safety and quality outcomes, and help curb the oversupply of opioids that contributes to the most pressing public health crisis of our time. SN - 1535-2900 UR - https://neuro.unboundmedicine.com/medline/citation/31505561/Optimizing_opioid_prescribing_and_pain_treatment_for_surgery:_Review_and_conceptual_framework_ DB - PRIME DP - Unbound Medicine ER -