Chronic Use of Opioids Before And After Bariatric Surgery
Friday, November 22, 2013
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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Friday, November 22, 2013
Opioids are not just for pain management. Many pain patients on chronic opioids use them for ‘euphoria management’. As well, chronic opioid use leads to periods of rebound pain even when the source of pain has been largely alleviated — as in losing massive amounts of weight. I know there is an appropriate and compassionate place for chronic opioids in non-malignant pain management but every effort has to be made to try to avoid starting patients down this road because for many there will be no coming back.
Friday, November 22, 2013
I had bariatric surgery in the hope of lessening my back pain. I didn’t lose as much as I wished, only about 70 pounds, but I found that my pain increased afterwards rather than decreased. I am on opioids and I suspect I will be until I die. It seems that the doctors first suggestion when approached with chronic pain is always that the patient should lose weight. But I founds that weightloss did not improve anything in the pain category. It is a great disappointment.
Friday, November 22, 2013
Is this increase opioid use a representation of “addiction transfer”? The reduced intake of hyperpalatable foods post surgery leaves the patient still wanting, unable to satisfy with eating, turning to more opioids. Reminder, the taste of hyperpalatable foods and the immediate release of internal (endogenous) opioids (endorphins) creates the strong positive emotiional experience of eating. Post surgery exogenous opioids may be available and do the trick??
Saturday, November 23, 2013
Doesn’t this more likely point to underlying self medication/addiction issues (that patients have been using food for) that are not taken care of by the surgery? From what I understand, drinking more, gambling more, etc. is really common after WLS. It doesn’t surprise me that opioid usage would be, too. I am not sure that it has a lot to do with increased pain.
Saturday, November 23, 2013
Many patients begin to exercise after surgery and probably exacerbate arthritic conditions thereby requiring pain medication. Many patients are also seek surgery to lose weight in order to have knee and hip replacements. They will still require pain mgmt after weight loss surgery and joint replacement surgery. Pre-surgery education regarding realistic expectations and goal setting is key for patients to know what to expect after surgery.
Saturday, November 23, 2013
I was not on any pain killers prior to gbs .following surgery joint pain seemed to increase for about a year after hitting goal. I lost 270 lbs. I do see a chiropractor for relief . I now am in no pain . He did explain that since I was active at 448lbs, which was good but when I lost this weight and quite quickly , the muscles and skeletal structure had a lot of changes to get used to. From walking different , to sleeping differently! He was right I was patient and he helped immensely !