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Chronic use of prescription painkillers continues following bariatric surgery

02.10.2013
Study first to assess long-term use of prescription painkillers for chronic, non-cancer pain management among patients pre- and post-obesity surgery

Chronic use of prescription painkillers, also known as opioids, among obese patients prior to bariatric surgery continues after surgery, according to a new Kaiser Permanente study published today in the Journal of the American Medical Association.

Researchers examined the electronic medical records of 11,719 obese patients who underwent bariatric surgery between 2005-2009 at one of 10 U.S. sites in the Scalable Partnering Network. Participating patients were evaluated one year before and one year after surgery. Seventy-seven percent of the obese patients who exhibited chronic opioid use prior to surgery continued to use these medications chronically one year after their procedure. Chronic opioid use among these patients also increased by 13 percent the first year after surgery.

"Obese patients are often more sensitive to pain and tend to be prescribed increasing opioid doses in order to manage that pain," said lead study author Marsha A. Raebel, PharmD, a senior investigator at Kaiser Permanente's Institute for Health Research.

In the year prior to their surgical procedures, 56 percent of the patients in this study reported no opioid use for pain management, 36 percent used some opioids and 8 percent used opioids on a chronic basis. Chronic opioid use was defined as having 10 or more prescriptions over at least 90 days or at least a 120-day total supply of medication sometime in the year prior to surgery. Some opioid use was defined as one to nine prescriptions over 90 days or less than a 120-day supply.

"There are limited options for pain management available to bariatric surgery patients because non-steroidal, anti-inflammatory medications increase the risk of ulcers, particularly after bariatric surgery," said Dr. Raebel. "Given the increasing chronic usage rate reported in this study, it's clear that the medical community needs to develop better pain management programs for patients who use opioids long-term following bariatric surgery."

More than 200,000 bariatric surgeries were performed in the U.S. in 2012 and prescription painkiller usage has exploded at the same time. According to the medical journal Pain, 4.3 million adults use opioid medications on a regular basis. The most commonly used prescription opioids are hydrocodone, oxycodone and morphine. Long-term opioid use can lead to many health issues, the most serious being addiction and fatal overdoses.

Kaiser Permanente is committed to furthering understanding of chronic opioid use. Earlier in 2013, a Kaiser Permanente study found that regularly taking opioids increases a man's risk of erectile dysfunction.

Kaiser Permanente can conduct transformational health research like this in part because it has the largest private patient-centered electronic health record system in the world. The organization's electronic health record system, Kaiser Permanente HealthConnect®, securely connects 9.1 million patients to 17,000 physicians in 611 medical offices and 37 hospitals. It also connects Kaiser Permanente's research scientists to one of the most extensive collections of longitudinal medical data available, facilitating studies and important medical discoveries that shape the future of health care delivery for patients and the medical community.

Additional study authors include: Sophia R. Newcomer, MPH, Liza M. Reifler, MPH, and Elizabeth A. Bayliss, MD, MSPH, of the Kaiser Permanente Institute for Health Research; Denise Boudreau, PhD, of Group Health Research Institute, Seattle; Thomas E. Elliott, MD, of the Essentia Institute of Rural Health, Duluth, Minn.; Lynn DeBar, PhD, of the Kaiser Permanente Center for Health Research, Portland, Ore.; Ameena Ahmed, MD, MPH, and David Fisher, MD, of the Permanente Medical Group, San Francisco; Pamala A. Pawloski, PharmD, of the HealthPartners Institute for Education and Research, Minneapolis; and W. Troy Donahoo, MD, of the Colorado Permanente Medical Group, Denver.

About the Kaiser Permanente Colorado Institute for Health Research

The Kaiser Permanente Colorado Institute for Health Research (IHR) publishes and disseminates epidemiologic, behavioral, and health services research to improve the health and medical care of Kaiser Permanente members and the communities it serves. The organization has a specific focus on conducting research that can be translated into clinical practice, health promotion, and policies to influence the health of individuals and populations. Currently, the IHR's staff of more than 120 is working on more than 160 epidemiological, clinical, behavioral, community, and health services research projects. Now in its 20th year of operation, the IHR is responsible for many landmark findings. Among the most notable are recent studies about vaccine safety and refusal, and home blood-pressure monitoring and research that identified life-saving practices for heart attack patients in the emergency room. Teams of investigators collaborate on major research projects with national partners including the Centers for Disease Control and Prevention Vaccine Safety Datalink, the HMO Research Network, and the NIH Cardiovascular Research Network and the Cancer Research Network. Learn more at http://kpco-ihr.org.
About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 9.1 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.

Vincent Staupe | EurekAlert!
Further information:
http://kp.org/share
http://kpco-ihr.org

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