Opioids Increase the Risk of Prolonging Postoperative Pain, Claims Study

While it is common to give prescription drugs to patients after a surgery, a recent study questions the prevailing practice. The study on mice indicated that opioid use after surgery could be counterproductive. The finding has led to concerns among various stakeholders, including medical practitioners, experts, scientists, etc., who fear its consequences on the pain management of patients.

The study highlights some of the lesser-known darker aspects of opioids that are likely to worsen the ongoing battle with opioid crisis. As human physiology of both the mammals – mice and humans – is quite similar, the researchers are apprehensive. Linda Watkins and Peter Grace from the University of Colorado Boulder performed exploratory abdominal surgery on male rats.

Also known as laparotomy, it is a fairly common surgery in America. During the course of the study, around three experiments were conducted to understand the impact of morphine in the long run. Firstly, one half of the rats were administered a moderate dose of morphine for seven days after the surgery and another half was given a saline solution. Secondly, mice were given morphine for eight days and then tapered off on the 10th day. Lastly, mice were given morphine for 10 days, after which it was abruptly withdrawn.

Some of the eye-opening findings were as follows:

Rats on morphine experienced pain for longer than three weeks.
The longevity of pain depends on the duration of the intake of morphine; the consumption of morphine for long makes the pain last longer.
Gradual tapering made no impact on the pain; this was not a result of withdrawal, rather other factors at work.

Researchers identified that the extension of postoperative pain was primarily caused due to increased expression of inflammatory genes, including those encoding Toll-like receptor 4 (TLR4), NOD-like receptor protein 3 (NLRP3), nuclear factor kappa B (NF-κB), caspase-1 (CASP1), interleukin-1β ((IL-1) and tumor necrosis factor.

Nonopioid alternatives for tackling pain

The opioid crisis is undoubtedly one of the worst epidemics to ravage America in recent times. While a couple of years ago opioids were considered as the best cure for chronic pain, they are now under intense scrutiny. Stanford pain specialist Sean Mackey concurs that opioids should never be the first-line treatment due to the risks attached to them. Instead, nonopioid alternatives should be tried first, he suggested.

According to Mackey, there are currently over 200 odd nonopioid medications for pain. Nonopioid medications, like acetaminophen used for osteoarthritis, lower back pain and migraine, do not lead to fatal overdoses associated with opioids. Similarly, topical agents, such as tricyclic antidepressants (TCAs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are used for treating localized musculoskeletal pain, osteoarthritis, etc.

Nonpharmacologic interventions, like exercise therapy and cognitive behavioral therapy (CBT), play a crucial role in the management of pain. While exercise therapy improves the overall well-being and promotes happiness in patients, CBT reduces pain and enhances functioning in daily life. Apart from educating the patient about relaxation techniques and sequenced breathing, CBT guides him/her through developing coping strategies required for mitigating pain.

Timely intervention essential for recovery

Being highly addictive in nature, prescription drugs, specifically opioid painkillers like Vicodin and hydrocodone, increase the risk of developing an addiction. Timely intervention is essential for containing the spread of the addiction. If left untreated, the consequences of prescription drug abuse could be fatal.

More than anything else, it is necessary to recognize every person living with pain has his or her own unique story and needs. Not everyone who lives with pain will respond in the same way to treatment. So, while exercise therapy and medications could work for one, they would not necessarily work for others. Therefore, one needs to be careful and cautious while taking these medicines.