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

Debora M Hofer; Michael Harnik; Thomas Lehmann; Frank Stüber; Philipp Baumbach; Johannes Dreiling; Winfried Meissner; Ulrike M Stamer

doi:10.1016/j.bja.2023.12.002

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

Br J Anaesth. 2024 Mar;132(3):588-598. doi: 10.1016/j.bja.2023.12.002. Epub 2024 Jan 10.

Authors

Debora M Hofer¹, Michael Harnik¹, Thomas Lehmann², Frank Stüber³, Philipp Baumbach⁴, Johannes Dreiling⁴, Winfried Meissner⁴, Ulrike M Stamer⁵

Affiliations

¹ Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
² Institute of Medical Statistics, Computer and Data Sciences, University Hospital Jena, Jena, Germany.
³ Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of BioMedical Research, University of Bern, Bern, Switzerland.
⁴ Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany.
⁵ Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of BioMedical Research, University of Bern, Bern, Switzerland; Pain and Opioids after Surgery (PANDOS) European Society of Anaesthesiology and Intensive Care (ESAIC) Research Group, Brussels, Belgium. Electronic address: ulrike.stamer@unibe.ch.

PMID: 38212183
DOI: 10.1016/j.bja.2023.12.002

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Clinical trial registration: NCT02083835.

Keywords: ICD-11; chronic postsurgical pain (CPSP); long-term opioid use; pain-related interference; patient-reported outcomes; persistent opioid use; postoperative opioids; surgery.

MeSH terms

Analgesics, Opioid / therapeutic use
Chronic Pain* / drug therapy
Chronic Pain* / epidemiology
Humans
Opioid-Related Disorders* / drug therapy
Opioid-Related Disorders* / epidemiology
Pain, Postoperative / chemically induced
Pain, Postoperative / drug therapy
Pain, Postoperative / epidemiology
Registries

Substances

Analgesics, Opioid

Associated data

ClinicalTrials.gov/NCT02083835