Pain or No Pain, We Will Give You Opioids: Relationship Between Number of Opioid Pills Prescribed and Severity of Pain after Operation in US vs Non-US Patients.

El Moheb, Mohamad; Mokhtari, Ava; Han, Kelsey; van Erp, Inge; Kongkaewpaisan, Napaporn; Jia, Zhenyi; Rodriguez, Gabriel; Kongwibulwut, Manasnun; Kaafarani, Haytham Ma

BACKGROUND Patients in the US receive disproportionally higher amounts of opioids following surgery compared to their non-US counterparts. We aimed to assess the relationship between perceived pain severity after surgery and the amount of opioid medications prescribed at discharge in US vs. non-US patients. METHODS We conducted a post-hoc analysis of the International Patterns of Opioid Prescribing (iPOP) multicenter study. Patients aged 16 and older who underwent appendectomy, cholecystectomy, or inguinal herniorrhaphy in one of 14 participating hospitals across 8 countries between October 2016 and March 2017 were included. In hospitals where pain severity was assessed using a 0-10 visual analog scale before hospital discharge, patients were stratified into four groups depending on the pain severity: none, mild (1-3), moderate (4-6) and severe (7-10). The number of opioid prescriptions, total number of pills, and oral morphine equivalents (OMEs) prescribed were calculated for each group and a comparison between US and non-US patients was performed. RESULTS A total of 2,024 patients were included. Eighty-three percent of US patients without pain were prescribed opioids compared to 8.7% of non-US patients without pain (p-value <0.001). The number of opioid prescriptions, the number of pills and OMEs prescribed were similar across the four pain severity groups in US patients (p-values >0.05). In contrast, the number of opioid prescriptions and the number of opioid pills and OMEs prescribed among non-US patients were incrementally higher as the pain severity progressed from no pain to severe pain (all p-values <0.05). CONCLUSION US patients are prescribed opioids at high rates and doses regardless of pain severity. Further efforts should be directed towards tailoring opioid prescriptions to patients' needs.