Excessive prescribing of pain medications after surgery has contributed to the epidemic of opioid misuse and diversion in the United States. Pain specialists may be particularly well situated to address these issues. We describe an attempt to reverse the trend at an orthopedic surgical hospital by implementing a peri-operative assessment and treatment service which minimizes preoperative opioid use, when necessary implements addiction treatment, and encourages early tapering from opioids.
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References
1.
B.J.Morris and H.R.Mir, “The Opioid Epidemic: Impact on Orthopaedic Surgery,”Journal of the American Academy of Orthopaedic Surgery23, no. 5 (2015): 267–271.
2.
S.J.Armaghaniet al., “Preoperative Opioid Use and Its Association with Perioperative Opioid Demand and Postoperative Opioid Independence in Patients Undergoing Spine Surgery,”Spine39, no. 25 (2014): E1524-1530.
3.
M.S.Angst and J.D.Clark, “Opioid-Induced Hyperalgesia: A Qualitative Systematic Review,”Anesthesiology104, no. 3 (2006): 570-587.
4.
See Morris, supra note 1.
5.
D.Dowel, T.M.Haegerich, and R.Chou, “CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016,”Morbidity and Mortality Weekly Reports Recommendations and Reports65, no. 1 (2016):1–49.
6.
E.M.Soffinet al., “An Evidence-Based Approach to the Prescription Opioid Epidemic in Orthopedic Surgery,”Anesthesia & Analgesia125, no. 5 (2017):1704-1713.
7.
“Preoperative Reduction of Opioid Use Before Total Joint Arthroplasty,”Journal of Arthroplasty31 (2016): S282–287, at S283-286; see also: K.M. Dunn et al., “Opioid Prescriptions for Chronic Pain and Overdose: a Cohort Study,” Annals of Internal Medicine 152, no. 2 (2010): 85-92.
8.
H.Clarke, “Transitional Pain Medicine: Novel Pharmacological Treatments for the Management of Moderate to Severe Post-Surgical Pain,”Expert Review of Clinical Pharmacology9, no. 3 (2016): 345–349.
