"My own prescribing habits have changed in that we tend to work with patients more closely on preoperative expectations regarding pain control, limiting the amount of narcotics that we provide, and looking at other medications that are not dependency-inducing to take their place.
As importantly, moving forward, is that we have two studies that are IRB-approved going on at Virginia Mason looking at pain control postoperatively. Specifically, we’re looking at alternatives to opiates for standard urologic procedures. An additional IRB-approved study is looking at opioid exposure in patients who had surgery a decade ago and seeing what risk we are putting those patients in. Does exposure to opioids prime those patients for future issues with those same drugs?
It’s a retrospective pilot study of 100 patients, but the issue is important urologically—regionally and nationally. Understanding those risks so we can develop better strategies moving forward is really critical.
These patients had radical prostatectomies 8-10 years ago and were involved in a pain-based study looking at whether belladonna and an opiates suppository at the time of surgery improved their postoperative perception of pain.
Looking at those same patients a decade later, we know exactly what narcotics they were exposed to at the time of that surgery. We’re asking about their recollection of their pain from that surgery, but just as importantly, about their pain issues today. Are they on chronic pain medicine? When they’ve had surgery since then, have they had higher narcotic requirements than we might expect? Essentially, we’re using pilot data to determine if previous exposure to opioids impacts their need for it a later date.”
John Corman, MD / Seattle
Next: "We’ve always tried to avoid the use of narcotics if possible, but a lot of what we deal with is acute pain."