SMS monitoring of pain, opioid use after surgery suggests that patients are overprescribed

Monitoring pain and opioid use via SMS after surgery can allow clinicians to better adjust prescriptions and avoid over-distribution of opioids. These results of a quality improvement study were published in JAMA Network Open.

Patients who underwent orthopedic (n = 742) or urological (n = 177) surgeries at the University of Pennsylvania Hospital or Penn Presbyterian Medical Center in 2019 were invited to participate in this study.

The patients were asked by SMS to rate pain intensity and tolerance on a scale of 0 to 10 points, with 10 being the most painful or tolerable pain, and asked about their opioid use and plans to use their opioid drugs in the coming days. The messages were sent on days 7, 14, 21, and 28 after surgery and stopped when patients reported that they were no longer using their pain medication.

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Patients who underwent orthopedic or urological interventions had an average age of 48 years (interquartile range) [IQR], 32-61) and 56 (IQR, 40-67), 51.8% and 15.2% were women and 66.7% and 80.7% were white. Compared to patients who refused to participate in the study (n = 1,118), the participating patients who underwent orthopedic surgery were younger (P <0.001), less ethnically diverse (P <0.001), and more opioid. naive (P =). 003).

In orthopedic operations, the mean pain on day 4 was given as 4.72 (standard deviation) [SD]2.54). The pain intensity varied depending on the surgical intervention and ranged from the repair of the upper extremity (mean 3.60; SD 2.71) to the fracture of the upper extremity with a non-distal radius (mean 6.38; SD 2.33).

The total pain intensity decreased by 0.89 (SD, 1.64) on day 7, by 1.32 (SD, 2.04) on day 14 and by 0.40 (SD, 1.91) on day 21. 2.59) on day 4.

Among the urological procedures, the total pain intensity was 3.48 (SD, 2.43) and the pain management ability was 7.34 (SD, 2.81) on day 4. The pain intensity was reported to decrease by 1.20 on day 7 (SD, 2.38) decreased by 1.18 (SD, 2.38) SD, 1.47) on day 14 and 1.50 (SD, 2.12) on day 21.

Patients undergoing orthopedic and urological procedures were prescribed a median of 20 (IQR, 15-30) and 7 (IQR, 5-10) opioid tablets, and 21.1% and 11.1% received one within 30 days Refill. After orthopedic surgery, patients consumed a median of 6 (IQR, 0-14) tablets, with the greatest consumption occurring in patients who had undergone a hip replacement (median 15; IQR, 5-21). During urological interventions, the patients consumed a median of 1 (IQR, 0-4) tablet.

On day 7, the mean number of opioid tablets consumed among all patients was 0 (IQR, 0-2). A total of 15,581 tablets were prescribed and 9452 were not used. Most patients (64.1%) used less than half of their tablets, and 27.8% did not use any of their prescribed opioids.

This study may have been biased by the high rate of non-response and the significantly different characteristics between responders and non-responders in the orthopedic surgery cohort.

These data showed that patients were prescribed far more opioid tablets than needed after orthopedic or urological surgery. Monitoring text messages can provide additional information that better informs clinical decisions about opioid distribution.


Agarwal AK, Lee D., Ali Z. et al. Patient reported opioid use and pain intensity after common orthopedic and urological surgery using an automated SMS system. JAMA Netw Open. 2021; 4 (3): e213243. doi: 10.1001 / jamanetworkopen.2021.3243

This article originally appeared on Clinical Pain Advisor

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