Trajectories of pain and opioid use up to one year after surgery: analysis of a European registry

• Published in: British journal of anaesthesia : BJA Vol. 132; no. 3; pp. 588 - 598
• Main Authors: Hofer, Debora M., Harnik, Michael, Lehmann, Thomas, Stüber, Frank, Baumbach, Philipp, Dreiling, Johannes, Meissner, Winfried, Stamer, Ulrike M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.03.2024
• Subjects: chronic postsurgical pain (CPSP); ICD-11; long-term opioid use; pain-related interference; patient-reported outcomes; persistent opioid use; postoperative opioids; surgery; postoperative opioids; patient-reported outcomes; ICD-11; chronic postsurgical pain (CPSP); persistent opioid use; long-term opioid use; pain-related interference; surgery
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1016/j.bja.2023.12.002

Long-term opioid use after surgery is a crucial healthcare problem in North America. Data from European hospitals are scarce and differentiation of chronic pain has rarely been considered. In a mixed surgical cohort of the PAIN OUT registry, opioid use and chronic pain were evaluated before surgery, and 6 and 12 months after surgery (M6/M12). Subgroups with or without opioid medication and pre-existing chronic pain were analysed. M12-chronic pain was categorised as chronic postsurgical pain (CPSP) meeting the ICD-11 definition, chronic pain related to surgery not meeting the ICD-11 definition, and chronic pain unrelated to surgery. Primary endpoint was the rate of M12 opioid users. Variables associated with M12 opioid use and patient-reported outcomes were evaluated. Of 2326 patients, 5.5% were preoperative opioid users; 4.4% and 3.5% took opioids at M6 and M12 (P<0.001). Chronic pain before operation and at M6/M12 was reported by 41.2%, 41.8%, and 34.7% of patients, respectively (P<0.001). The rate of M12 opioid users was highest in group unrelated (22.3%; related 8.3%, CPSP 1.5%; P<0.001). New opioid users were 1.1% (unrelated 7.1%, related 2.3%, CPSP 0.7%; P<0.001). M12 opioid users reported more pain, pain-related physical and affective interference, and needed more opioids than non-users. The predominant variable associated with M12 opioids was preoperative opioid use (estimated odds ratio [95% confidence interval]: 28.3 [14.1−56.7], P<0.001). Opioid use was low in patients with CPSP, and more problematic in patients with chronic pain unrelated to surgery. A detailed assessment of chronic pain unrelated or related to surgery or CPSP is necessary. NCT02083835.