Chronic Use of Opioids Before And After Bariatric Surgery

One of the most common complications of excess weight is chronic pain, not infrequently requiring the use of opioid pain killers.

For such patients, one of the greatest hopes is that the weight loss resulting from bariatric surgery will ease their pain to an extent that would not only improve their mobility but also obviate the need for opioid medications.

Now, a paper by Marsha Raeble and colleagues from Kaiser Permanente, Denver, CO, published in JAMA looks at opioid use following bariatric surgery in almost 12,000 patients using opioids chronically for pain control prior to their surgery.

Of the 933 (8%) bariatric patients, who were chronic opioid users before surgery, 723 (77%) continued chronic opioid use in the year following surgery.

In fact, the daily morphine equivalents in chronic users increased from a preoperative mean of 45 mg to 52 mg and almost 20% increase.

This increased use of opiate use was unrelated to the actual weight loss or to the presurgical presence of depression and/or chronic pain.

Thus, the authors conclude that in this large cohort of patients who underwent bariatric surgery, three out of four patients who were chronic opioid users before surgery continued chronic opioid use in the year following surgery, and the amount of chronic opioid use was greater postoperatively than preoperatively.

These findings speak to the need for better pain management after bariatric surgery and warn us about expecting too much in terms of pain relief even from the rather dramatic weight loss seen with surgery in these patients.

If you have experience (positive or negative) with pain before and after bariatric surgery, I’d certainly like to hear about it.

@DrSharma
Edmonton, AB

Hat tip to Scott Kahan for pointing me to this article

Raebel MA, Newcomer SR, Reifler LM, Boudreau D, Elliott TE, DeBar L, Ahmed A, Pawloski PA, Fisher D, Donahoo WT, & Bayliss EA (2013). Chronic use of opioid medications before and after bariatric surgery. JAMA : the journal of the American Medical Association, 310 (13), 1369-76 PMID: 24084922

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