A new approach almost halved the use of opioid analgesics in surgical oncology patients without increasing their pain or anxiety. The two-prong approach included maximizing the use of over-the-counter nonopioid therapies and changing the nature of postsurgery discussions with patients.

These findings will be presented at the American Society of Clinical Oncology's (ASCO's) upcoming Quality Care Symposium. "While opioids can be an effective pain management tool for cancer patients, there is a risk of addiction, particularly for people who have recently undergone surgery," said lead author Kerri Stevenson, NP, Stanford Health Care, California, in an ASCO press release.

"We found that when you have conversations with patients about pain control, including nonopioid therapies available and the potential risks associated with opioids, they appreciate being involved in their care and, subsequently, have a reduced need for opioid medications," she said.

Opioid overuse and misuse have become a top public health concern. Recent data suggest that the situation is getting worse rather than improving, as reported by Medscape Medical News.

Opioid overdose

In 2016, more than 40,000 Americans died from an opioid overdose. For many individuals, the first encounter with opioids comes when opioids are prescribed for acute pain management following surgery.

An estimated 6% of patients who are not regular users of opioids become newly addicted to these medications post surgery. One recent study found that 10% of cancer patients who underwent curative surgery were still filling opioid prescriptions one year after the procedure.

Use Reduced by 46%

In the latest study, Stevenson and her colleagues aimed to reduce reliance on opioid medications in managing postoperative pain by 50%, from baseline morphine equivalent daily dose (MEDD) of 95.1 to a target MEDD of 47.5.

The authors retrospectively reviewed daily opioid use, pain scores, and anxiety scores for inpatients recovering from surgery for urologic cancers at a high-volume surgical department during a 4-month period. They then used these data to design a "two-pillared" strategy.

The first pillar was focused on developing care pathways for postoperative pain control utilizing nonopioid medications and therapies as the first line. This included designing opioid-sparing pain regimens, using varying combinations of acetaminophen, ketorolac, gabapentin, and local anesthetics, and identifying key drivers that were needed to decrease excess opioid use reliably.

Providers and nurses were educated about the availability and efficacy of the treatment plans, and although patients were still prescribed opioids, prescribing was at lower doses, and dosing was only escalated if necessary.