When it comes to providing patients with the right care plan after surgery, opioids and pain medications are often part of the discussion. For some patients, opioids can help to control pain and help the patient stay in a positive frame of mind because they aren’t bogged down with pain and discomfort. For others, opioids are unnecessary and downright dangerous given their risk of dependency.
Each patient should be evaluated on an individual basis to determine if opioids are the best option for them after their foot or ankle surgery, but a recent study helped shine a light on when they might not be necessary. According to research published in the Journal of the American Academy of Orthopaedic Surgeons, they found no association between opioid intake and patient satisfaction with treatment or pain management after surgery to address a fractured ankle. In fact, pain relieving opioids could actually have the opposite effect.
“Our study found disability and satisfaction to be related to ineffective coping strategies in response to nociception,” said David Ring, MD, PhD, from the Department of Surgery and Perioperative Care at the University of Texas at Austin Dell Medical School. “Opioids should relieve pain, but greater opioid consumption was associated with greater pain.”
Ankle Fractures and Opioids
For their study, Dr. Ring and colleagues examined 102 patients who underwent surgical management for a fractured ankle. Researchers tracked a number of different factors, including opioid use, patient disability, pain and overall treatment satisfaction after surgery and at five months and eight months post op.
After looking at the results, researchers uncovered that after surgery, there was no link between opioid intake and pain management or treatment satisfaction. The same was seem at the five- and eight-month intervals. However, researchers did find an association between catastrophic thinking and pain anxiety in patients who were still taking opioids at the five- and eight-month checkups.
Researchers concluded that patients should be carefully screened before and after ankle fracture surgery to determine how pain relievers would be best used after the operation. Doctors should also consider other pain management and treatment options after surgery instead of simply relying on opioids.
“In some studies, opioid use is associated with an increase in disability and decreased patient satisfaction,” Dr Ring and colleagues wrote. “In our opinion, to improve pain relief, surgeons should proactively address stress, distress, and ineffective coping strategies. Additional studies should examine how best to address stress and improve coping mechanisms, such as through coaching based on cognitive behavioral therapy.”
