By Bob Kronemyer
An automated text messaging system for patients to self-report opioid consumption and pain intensity after undergoing one of two common surgical procedures revealed that 61% of prescribed short-term opioid tablets were unused and 28% of patients did not take any opioids at all, in a new study.
The prospective quality improvement study, published in JAMA Network Open (2021;4[3]:e213243) also found that for orthopedic procedures, the mean pain score (on a scale of 0-10) on day 4 was 4.72, with a mean change by day 21 of –0.40.
Similarly, the mean ability to manage pain (on a scale of 0-10, with 10 representing very able to control pain) in this orthopedic population on day 4 was 7.32, with a mean change of –0.80 by day 21.
For patients who underwent urologic procedures, the mean pain score on day 4 was 3.48, with a mean change by day 21 of –1.50, whereas the mean ability to manage pain score on day 4 was 7.34, with a mean change of 0.80 by day 14.
“Our intent was to develop a scalable approach to engage patients following common surgeries to better understand postoperative pain and use of prescription pain medications, including opioids,” said principal investigator Anish Agarwal, MD, MPH, an assistant professor of emergency medicine at the University of Pennsylvania Perelman School of Medicine, in Philadelphia. “Research has shown that there is often a mismatch between the amount of opioids prescribed following surgery and what patients actually use, thus resulting in unused opioids in the community.”
Of the 919 study participants, 80.7% underwent orthopedic procedures and 19.2% underwent urologic procedures at either the Hospital of the University of Pennsylvania or Penn Presbyterian Medical Center, also both in Philadelphia, between May and December 2019.
Patients who underwent orthopedic procedures had a median age of 48 years, with 51.8% women and 66.7% white; 69.8% had an outpatient procedure. Among patients who underwent urologic procedures, the median age was 56 years, with 84.8% men and 80.7% white; 62% had an outpatient procedure.
One opioid tablet was defined as an oxycodone 5-mg tablet equivalent.
The median quantity of opioids prescribed for patients who had orthopedic procedures was significantly higher than self-reported consumption: 20 tablets (range, 15-30 tablets) versus six tablets (range, zero to 14 tablets).
This finding was similar in patients who had urologic procedures: seven tablets (range, five to 10 tablets) versus one tablet (range, zero to four tablets), respectively.
“Unfortunately, the incongruity persists in prescribing compared to actual use, and a majority of patients do not even use most of their prescribed opioids,” Dr. Agarwal said. “Furthermore, within seven days, most patients are finished using their opioids following common orthopedic and urologic surgeries.”
Dr. Agarwal, who is also a clinical innovation manager at Penn Medicine Center for Health Care Innovation, in Philadelphia, noted that the automated text messaging system is valuable by connecting with patients and developing data that surgeons can then use to guide their future prescribing.
“We are supported by the health system leadership and we have worked hard to ensure patient privacy and safety, which are key,” Dr. Agarwal said. “We learned a lot in the early days of developing this text system. For instance, we started small to ensure the system worked properly, that the data was reliable and that we were not interfering with normal clinical workflows. More recently, we have off-loaded the clinicians and can support them with patient-centered data.”
To increase the efficacy of an automated text messaging system to collect patient-reported opioid use and pain intensity, “we keep our system brief and to the point,” Dr. Agarwal said. “We do not want to overburden anyone, and we are constantly trying to think of methods which support the patients and community.”
Two limitations of the study, however, are that patients needed to have regular access to a text message device and that nonresponders were older, more likely to be Black and have comorbid conditions.
“We hope to continue to scale our text messaging system across our health system to other clinical areas and departments,” Dr. Agarwal said. “The more patient-centered data we can capture, the better equipped our providers can be to personalize and tailor pain management for specific procedures and/or injuries.”
Originally published by our sister publication, Pain Medicine News