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Current Drug Helps Cut Opioid Use After Surgery

Pills in blister packs

(PublicDomainPictures, Pixabay)

14 December 2017. Results from a clinical trial show patients given a current non-opioid pain medication with different types of surgery were less likely to use opioids for up to a year later. A team from Stanford University’s medical school and affiliated hospitals describes its findings in yesterday’s issue of the journal JAMA Surgery (paid subscription required).

Researchers led by anesthesiologist and pain medicine specialist Jennifer Hah are seeking safer options to help patients deal with pain following surgery. Opioids work by reducing the intensity of pain signals to the brain, particularly regions of the brain controlling emotion, which reduces effects of the pain stimulus. But by binding to receptors in the brain affecting emotions, opioids can also drive up dopamine levels, creating an addiction.

The authors cite data showing more than 51 million people in the U.S. undergo surgery each year, with most of those individuals prescribed opioids to help manage their pain, and nearly 1 in 7 surgery patients (13%) becoming chronic opioid users after surgery. In addition, patients receiving opioid drugs before their surgery need higher doses of drugs following their procedures, increasing the risk of abuse and overdose.

In the late-stage clinical trial, Hah and colleagues enrolled 410 individuals from a pool of some 1,800 prospects who received various surgical procedures between 2010 and 2014, such as breast lumpectomy or mastectomy, total knee or hip replacement, and carpal tunnel surgery. Participants, age 18 to 75, were randomly assigned to receive the drug gabapentin or placebos, both before and after their surgery.

Gabapentin is prescribed to control convulsions in people with epilepsy, but is also given to relieve intense pain associated with shingles, as well as neuropathic pain and restless leg syndrome. In the trial, patients were given 1,200 milligrams of gabapentin before the surgery — the drug also helps relieve anxiety and relax patients — then 600 milligrams at 3 times a day for 72 hours. Placebo participants received the anxiety drug lorazepam before surgery, and an inactive compound after the procedure, also for 72 hours.

The researchers tracked participants for up to 2 years following surgery, looking primarily for the amount of time needed for their post-surgical pain to subside, as well as the length of time before they stopped using opioid drugs, assessed at 6- and 12-month follow-ups. The results show patients receiving gabapentin and the placebos reported about the same amount of time for their pain to stop.

Gabapentin recipients, on the other hand, were 24 percent more likely to stop using opioids for pain relief sooner than those receiving a placebo, a difference large enough to be statistically reliable. Rates of adverse effects and discontinued use of the medications due to conditions such as dizziness or sedation were about the same for both groups.

The authors conclude that gabapentin can be a useful tool for surgeons to help their patients manage their post-surgical pain. The researchers caution, however, that the wide range of surgeries included in the study make it difficult to make a blanket recommendation for prescribing gabapentin, with issues such as dosing and timing that still need to be resolved.

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