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Shared decision-making approach to taper postoperative opioids in spine surgery patients with preoperative opioid use : a randomized controlled trial. / Uhrbrand, Peter; Rasmussen, Mikkel Mylius; Haroutounian, Simon et al.
In: Pain, Vol. 163, No. 5, 05.2022, p. e634-e641.Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review
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TY - JOUR
T1 - Shared decision-making approach to taper postoperative opioids in spine surgery patients with preoperative opioid use
T2 - a randomized controlled trial
AU - Uhrbrand, Peter
AU - Rasmussen, Mikkel Mylius
AU - Haroutounian, Simon
AU - Nikolajsen, Lone
PY - 2022/5
Y1 - 2022/5
N2 - ABSTRACT: Persistent opioid use is common after surgery, and patients with preoperative opioid use represent a major challenge in this regard. The aim of this randomized controlled trial was to determine the effect of a personalized opioid tapering plan vs standard of care in patients with a preoperative opioid use undergoing spine surgery at Aarhus University Hospital, Denmark. Postoperative outcomes included opioid use, pain, contacts with the healthcare system, patient satisfaction, and withdrawal symptoms. Overall, 110 patients were randomized; 55 into the intervention and control groups each. Five patients (proportion = 0.09, 95% confidence interval [CI] [0.04-0.21]) in the intervention group compared with 13 patients (0.25, 95% CI [0.15-0.39]) in the control group were unable to taper opioids to their preoperative consumption 1 month after discharge (P = 0.03) (primary outcome). Likewise, more patients in the intervention group succeeded in tapering opioids to zero 3 months after discharge (37 patients; 0.71, 95% CI [0.57-0.82] vs 23 patients; 0.43, 95% CI [0.30-0.56], P = 0.003). Fewer patients in the intervention group had pain-related contacts to health care the first 2 weeks after discharge (21 patients; 0.40, 95% CI [0.28-0.54] vs 31 patients; 0.60, 95% CI [0.46-0.73], P = 0.04). There was no difference in satisfaction with pain treatment over the first 2 weeks or the incidence of withdrawal symptoms during the first month after discharge. Pain intensity was similar between both groups at all time points. These results suggest that a personalized tapering plan at discharge combined with telephone counselling 1 week after discharge assists patients in postoperative opioid tapering.
AB - ABSTRACT: Persistent opioid use is common after surgery, and patients with preoperative opioid use represent a major challenge in this regard. The aim of this randomized controlled trial was to determine the effect of a personalized opioid tapering plan vs standard of care in patients with a preoperative opioid use undergoing spine surgery at Aarhus University Hospital, Denmark. Postoperative outcomes included opioid use, pain, contacts with the healthcare system, patient satisfaction, and withdrawal symptoms. Overall, 110 patients were randomized; 55 into the intervention and control groups each. Five patients (proportion = 0.09, 95% confidence interval [CI] [0.04-0.21]) in the intervention group compared with 13 patients (0.25, 95% CI [0.15-0.39]) in the control group were unable to taper opioids to their preoperative consumption 1 month after discharge (P = 0.03) (primary outcome). Likewise, more patients in the intervention group succeeded in tapering opioids to zero 3 months after discharge (37 patients; 0.71, 95% CI [0.57-0.82] vs 23 patients; 0.43, 95% CI [0.30-0.56], P = 0.003). Fewer patients in the intervention group had pain-related contacts to health care the first 2 weeks after discharge (21 patients; 0.40, 95% CI [0.28-0.54] vs 31 patients; 0.60, 95% CI [0.46-0.73], P = 0.04). There was no difference in satisfaction with pain treatment over the first 2 weeks or the incidence of withdrawal symptoms during the first month after discharge. Pain intensity was similar between both groups at all time points. These results suggest that a personalized tapering plan at discharge combined with telephone counselling 1 week after discharge assists patients in postoperative opioid tapering.
KW - CHRONIC NONCANCER PAIN
KW - Chronic pain
KW - Opioid tapering
KW - PRESCRIPTION
KW - Persistent postoperative opioid use
KW - Postoperative pain
KW - Preoperative opioid use
KW - Spine surgery
UR - http://www.scopus.com/inward/record.url?scp=85124761389&partnerID=8YFLogxK
U2 - 10.1097/j.pain.0000000000002456
DO - 10.1097/j.pain.0000000000002456
M3 - Journal article
C2 - 34433772
VL - 163
SP - e634-e641
JO - Pain
JF - Pain
SN - 0304-3959
IS - 5
ER -