b'Increased Use of Multimodal Non-Opioid Painkillers Urged for Post-Surgical PatientsVAMCs Are Incorporating the New Policies in Pain Management PlansBy Brenda L. MooneyWith a growing realization that post-surgical opioids might beTodothat,thestudyteamused neither the safest nor most effective way to reduce pain, VAnationwide VHA data on high-volume surgicalproceduresfrom2007-2014, facilities are using a variety of non-opioid painkillers to helpidentifying 235,239 veterans undergo-patients manage their discomfort after undergoing surgery. Ining orthopedic, general or vascular sur-gery. They categorized the participants fact, opioids are no longer considered first line treatment forinto three categories: 5.4% of them were considered high most types of acute pain, including that related to surgery. trajectories (116.1 oral morphine equivalents (OME) per day),53.2% as medium trajectories (39.7 OME/Day), and STANFORD, CAFor at least a decade,associated with surgery, according to 41.4% aslow trajectories (19.1 VA has been grappling with how to re- a prescribing guide. OME/Day). duce long term opioid prescriptions forWhythatisoccurringispartlySurprisingresultssuggestedthat veterans with chronic pain. One resultexplained by a study last year in thepatientsinthehighOMEgrouphad was the VAs Opioid Safety Initiative,AmericanJournalofSurgery,whichhigher risk of a pain-related readmis-whichhasreducedlong-termopioidsought to describe variation in periop- sion (OR: 1.59; CI: 1.39, 1.83) com-dispensing more than 50%. erative opioid exposure and its effectpared to the low OME trajectory. Anotherareawhereopioidsareon patients outcomes. 1 Inconclusion,patientsreceiving widely usedand suspected of beingThestudy,ledbyresearchersfromhighperioperativeOMEaremore overprescribedisintheshort- StanfordUniversityandtheVAPalolikely to return to care for pain-related termtreatmentofpainaftersurgery,AltoHealthCareSystem,lookedatproblems, the researchers wrote.although that has received less focusperioperativeexposuretomorphineBecauseofincreasedunderstanding untilrecently.Ithasbeensuggestedand its association with post-operativeof growing risks and possibly shrinking thatreceivingpost-surgicalopioidspain and 30-day readmissions.benefits for opioid analgesics, a website canbeariskfactorinbecoming dependentonthepainkillersovera more extended period of time.The bottom line: Opioids are no longer Onegame-changerhasbeenrecent researchfindingthatmanagingpainconsidered first-line treatment for most types withopioidsdoesntnecessarilyof acute pain, including that associated with improve surgical outcomes. The bot-tom line: Opioids are no longer con- surgery, according to a prescribing guide.sideredfirst-linetreatmentformost typesofacutepain,includingthat Continued on Page 19 u14 2020 COMPENDIUM OF FEDERAL MEDICINE'