(96) Variations in The Definitions for Prevalence of Chronic Post-Surgical Pain and Persistent Opioid Use After Surgery

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 770

Presenting Author(s)

Neetu Bansal, MRPharmS, MSc
– PhD postgraduate researcher in pain management, University of Manchester, University of Manchester, Manchester, United Kingdom

Co-Author(s)

Li-Chia Chen
– Senior Lecturer, University of Manchester, England, United Kingdom
Sheanne Ang
– Trainee Pharmacist, Norfolk and Suffolk NHS Foundation Trust, Norwich, United Kingdom

Background: Chronic post-surgical pain (CPSP), a well recognised complication after surgery, is often interchangeably labelled as persistent opioid use (POU), which is associated with detrimental outcomes, e.g., drug addiction, drug misuse and opioid related deaths.

Objectives: Objectives
This review aimed to investigate the definition, prevalence of CPSP, POU and the detrimental outcomes related to opioid use after surgery.

Methods: An electronic database search was conducted by applying structured search strategies in PubMed, MEDLINE, EMBASE, CINAHL Plus and Cochrane Database of Systematic Reviews from inception to March 2021. Systematic reviews and meta-analyses evaluating CPSP, POU and opioid-related detrimental outcomes in selective major elective surgical procedures were included. Data related to the definition, prevalence and risk factors of CPSP, POU and opioid-related detrimental outcomes were extracted and summarised. The quality of studies was assessed based on the AMSTAR-2 tool.

Results: Of the 13 systematic reviews and meta-analyses identified, 4 and 8 studies reported the prevalence of CPSP and POU respectively. No studies assessed the opioid-related detrimental outcomes in patients who received major surgeries. Most of the reviews were of medium to good quality (fulfilled 9-11 over the 16 AMSTAR-2 criteria). The prevalence of CPSP and POU, commonly synthesized at 3, 6, or 12 months after surgeries, widely varied from 9-70% and 0.01-77%, respectively. There was significant heterogeneity in patient characteristics (from age≥13 years), types of surgeries, follow-up duration, and the definitions of measures. CPSP was commonly defined as pain lasting ≥3 months after surgery, but unspecified terms (persistent post-surgical pain, long-term pain, and chronic pain) measured in 3 months to 12 years were also employed. PPOU was measured by various prescription patterns (use or persistent use with non-standardized definitions) and duration (2-12 months), such as ’filling at least one opioid prescription” from ‘’after 60 days’’ to ‘’after 90 days’’ of surgery.

Conclusions: The prevalence of CPSP and POU remains unknown. Consensus is needed to understand the true prevalence and assess risk factors associated with different outcomes, informing future clinical practice and policy decision-making to optimize pain management and medication safety.