Michigan study shows success in decreasing opioids without increasing post-surgical pain – MLive.com

Michigan post-surgical patients sent home with a reduced number of opioid painkillers showed no difference in controlling pain compared to patients given more painkillers, according to a new study.

More than 40 Michigan hospital reduced by nearly one-third the number of opioid pills they prescribed to patients having nine common operations, from an average of 26 per patient to an average of 18, said a press release from Michigan Medicine at University of Michigan.

But the ratings those patients gave for their post-surgery pain and satisfaction didn’t change from the ratings given by patients treated in the six months before the opioid-reducing effort, according to a research letter in the New England journal of Medicine.

In fact, patients reported that they only took half the opioids prescribed to them. Researchers attribute this drop in part to improved pre-surgery counseling about pain expectations and non-opioid pain control options.

The nine operations were: laparoscopic gall bladder removal, appendectomy, minor hernia repair, open ventral/incisional hernia repair, laparoscopic or open colectomy, and vaginal, abdominal or minimally invasive hysterectomy.

The research letter was written by Dr. Jocelyn Vu, a surgical resident at Michigan Medicine, and other members of Michigan Opioid Prescribing Engagement Network or Michigan-OPEN.

The study was a collaborative effort to help surgical teams follow evidence-based opioid prescribing guidelines developed at the University of Michigan.

The change in prescribing opioids comes in response to the nationwide opioid crisis.

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The study includes prescription data from 11,716 patients who had operations at hospitals participating in the Michigan Surgical Quality Collaborative. Just over half of the patients also filled out surveys sent to their homes after their operations, reporting on their pain, satisfaction and opioid use after surgery, the press release said.

The Michigan-OPEN team has worked since 2016 to study the role of surgical opioid prescribing in the start of new persistent opioid-taking behavior among patients, and to quantify how prescription size relates to number of opioids patients take, and their pain control, the press release said.

That research led to the development of evidence-based opioid prescribing guidelines first tested on gallbladder surgery patients at Michigan Medicine, before being expanded to other types of surgery.

In the time since the study ended, the Michigan-OPEN team has revised its surgical prescribing guideline to suggest even smaller prescriptions for these operations, and has added over 15 other operations and procedures

Meanwhile, a Michigan law aimed at reducing excess opioid prescribing for acute pain took effect just after the study period, though the law allows for a much larger prescription than the Michigan-OPEN guidelines recommend.

MSQC is funded by Blue Cross Blue Shield of Michigan to improve surgical quality and safety across the state. Michigan-OPEN is funded by the Michigan Department of Health and Human Services and BCBSM, and is based at the U-M Institute for Healthcare Policy and Innovation.

In addition to Vu and Englesbe, the research letter’s authors are Ryan A. Howard, MD; Vidhya Gunaseelan, MS; and Michigan-OPEN co-directors Chad M. Brummett, MD and Jennifer F. Waljee, MD. Englesbe, Brummett and Waljee are members of IHPI.