Alternatives to Opioids Reduce Misuse After Pancreatic Cancer Surgery

Alternatives to using opioid pills for patients receiving pancreatic cancer surgery for pain-relief have been found to reduce the risk of opioid misuse and addiction, according to recent research.

Specific alternatives such as nerve block procedures, early patient mobilization (physical activity soon after the surgery) and non-opioid medications, which include muscle relaxers and anti-inflammatory drugs, are recommended for patients with pancreatic cancer to manage pain after surgery, as reported in a press release from The University of Texas MD Anderson Cancer Center. This approach reduces the use of opioids, as they can lead to both misuse and addiction.

Implementing this approach compared with opioid prescriptions for patients who underwent pancreatic cancer surgery reduced the inpatient opioid use by 50% after surgery, the press release established. It also confirmed that this approach could help to reduce the risk of long-term opioid dependence in patients.

The press release also stated that although these alternatives to opioid pills are low-risk and low-cost, they were not often used because opioids are easier to prescribe. However, misuse and addiction to the drug has made doctors more mindful of what they prescribe to patients, the press release determined.

Pancreatic cancer surgery is known to be one of the most complex abdomen operations, particularly because it simultaneously affects several organs, causing severe pain among patients in the earlier stages of recovery, the press release noted. Because opioid pills are a strong pain-relieving medication, according to the press release, it was a medication often prescribed to patients after undergoing major surgeries.

“Patients not regularly taking opioids are at risk of developing a new dependence after surgery, and excess pills also create a risk of misuse by family members or others in their community,” Dr. Ching-Wei Tzeng, senior author of the study and associate professor of surgical oncology at The University of Texas MD Anderson Cancer Center, said in the press release. “Pancreatic cancer surgery can be a painful operation with a difficult recovery. This study shows that, even in this setting, easy-to-implement strategies can achieve effective pain control for our patients without putting them at risk for opioid dependence.”

The study from MD Anderson Cancer Center had a total of 832 patients who were undergoing pancreatic resection surgery (surgically removing a section of the pancreas). Among the 832 patients in the study, 541 patients received pancreatoduodenectomies (a surgery that removes the head of the pancreas), 285 patients received distal pancreatectomies (a surgery that removes the body or tail of the pancreas) and six patients received pancreatectomies (a surgery that removes the entire pancreas).

In the study, the results demonstrated that on a pain scale from one to ten (most painful), the median pain score was a three or less, in which the researchers saw no differences in post-discharge refill requests. The press release reported that most patients — regardless of the type of surgery they received — did not require opioid refills after they were discharged.

“Our enhanced recovery program, which includes generalizable protocols to reduce reliance on opioid medications, is the first to demonstrate continuous decreases in opioid use and distribution after pancreatic surgery,” Tzeng said. “By making purposeful, successive improvements to existing processes, we showed that we can reduce the amount of opioids patients need after a major surgery while ensuring they recover well without any extra costs.”

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