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A Systematic Review of Behavioral Interventions to Decrease Opioid Prescribing After Surgery.

David D Q Zhang1, Jess Sussman2, Fahima Dossa1

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This study found that various behavioral strategies effectively reduce postsurgical opioid prescribing at discharge. These interventions decreased opioid amounts without negatively impacting patient pain control, despite some study limitations.

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Area of Science:

  • Pain Management
  • Pharmacology
  • Health Services Research

Background:

  • Postsurgical opioid prescribing at discharge is highly variable and often excessive.
  • Current practices lack standardization, leading to potential overuse of opioids.

Purpose of the Study:

  • To systematically review and summarize behavioral interventions aimed at reducing postsurgical opioid prescribing upon discharge.
  • To evaluate the effectiveness of these interventions on opioid quantities and patient pain levels.

Main Methods:

  • A systematic literature search was conducted across major databases (MEDLINE, EMBASE, CINAHL, PsycINFO) up to December 2018.
  • Behavioral interventions were identified using the Cochrane EPOC taxonomy.
  • Risk of bias was assessed using Cochrane EPOC criteria and the Newcastle-Ottawa scale.

Main Results:

  • Twenty-four studies encompassing six types of behavioral interventions were included.
  • All interventions, except one, significantly decreased postsurgical opioid prescriptions.
  • Opioid reductions ranged from 34.4 to 212.3 mg morphine equivalents, with minimal impact on pain intensity.

Conclusions:

  • Multiple behavioral strategies can effectively reduce opioid prescribing after surgery.
  • These interventions show promise in optimizing postsurgical pain management and reducing opioid exposure.
  • Despite medium-to-high risk of bias in included studies, findings suggest a positive impact on prescribing practices.