Striking a Balance With Opioid Use for Pain Management After Thoracic Surgery

Abstract

Pain management for patients undergoing thoracic surgery is of paramount importance. As many as one-third of patients undergoing thoracic surgery, regardless of approach, may develop chronic pain 1 Bayman E.O. Parekh K.R. Keech J. Selte A. Brennan T.J. A prospective study of chronic pain after thoracotomy. Anesthesiology. 2017; 126: 938-951 Crossref PubMed Scopus (124) Google Scholar defined as pain related to surgery lasting at least 3 months. An independent predictor of chronic pain is pain intensity during the early postoperative period. 1 Bayman E.O. Parekh K.R. Keech J. Selte A. Brennan T.J. A prospective study of chronic pain after thoracotomy. Anesthesiology. 2017; 126: 938-951 Crossref PubMed Scopus (124) Google Scholar Therefore optimal pain management immediately after surgery is crucial. Furthermore 14% of lung cancer resection patients become new persistent opioid users, meaning they fill an opioid prescription for surgery and at least 1 additional prescription 3 months after surgery. 2 Brescia A.A. Harrington C.A. Mazurek A.A. et al. Factors associated with new persistent opioid usage after lung resection. Ann Thorac Surg. 2019; 107: 363-368 Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar Surgeons must strike a balance with opioids by prescribing them judiciously as part of a multimodal analgesia strategy to optimize postoperative pain management while minimizing risk of prolonged use. As eloquently stated by Travis Rieder, PhD, bioethicist, in his book entitled, In Pain, “We don’t have a prescription opioid problem; we have a pain problem that opioids happen to play a significant role in.” (page 157). 3 Rieder T. In Pain: A Bioethicist’s Personal Struggle with Opioids. HarperCollins, 2019 Google Scholar Multimodal Pain Management Protocol to Decrease Opioid Use and to Improve Pain Control After Thoracic SurgeryThe Annals of Thoracic SurgeryVol. 114Issue 6PreviewOpioid addiction continues to be a devastating problem in our communities, and up to 40% of patients begin their addiction with legally prescribed opioids after injury or surgical procedure. An opioid-free multimodal pain regimen was developed with the goal of decreasing opioid exposure while maintaining adequate pain control. Full-Text PDF