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Patient Preferences for Pain Control After Mohs Micrographic Surgery: A Single-Center Discrete Choice Experiment
Shannon T Nugent1, Surya A Veerabagu2, Matthew Madden3
1Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
Importance:
Patient preferences for pain medications after Mohs micrographic surgery are important to understand and have not been fully studied.
Objective:
To evaluate patient preferences for pain management with only over-the-counter medications (OTCs) or OTCs plus opioids after Mohs micrographic surgery given varying levels of theoretical pain and opioid addiction risk.
Design, Setting, And Participants:
This prospective discrete choice experiment was conducted in a single academic medical center from August 2021 to April 2022 among patients undergoing Mohs surgery and their accompanying support persons (≥18 years). A prospective survey was administered to all participants using the Conjointly platform. Data were analyzed from May 2022 to February 2023.
Main Outcome And Measure:
The primary outcome was the pain level at which half of the respondents chose OTCs plus opioids equally to only OTCs for pain management. This pain threshold was determined for varying opioid addiction risk profiles (low, 0%; low-moderate, 2%; moderate-high, 6%; high, 12%) and measured via a discrete choice experiment and linear interpolation of associated parameters (pain levels and risk of addiction).
Results:
Of the 295 respondents (mean [SD] age, 64.6 [13.1] years; 174 [59%] were female; race and ethnicity were not considered) who completed the discrete choice experiment, 101 (34%) stated that they would never consider opioids for pain management regardless of the pain level experienced, and 147 (50%) expressed concern regarding possible opioid addiction. Across all scenarios, 224 respondents (76%) preferred only OTCs vs OTCs plus opioids after Mohs surgery for pain control. When the theoretical risk of addiction was low (0%), half of the respondents expressed a preference for OTCs plus opioids given pain levels of 6.5 on a 10-point scale (90% CI, 5.7-7.5). At higher opioid addiction risk profiles (2%, 6%, 12%), an equal preference for OTCs plus opioids and only OTCs was not achieved. In these scenarios, patients favored only OTCs despite experiencing high levels of pain.
Conclusion And Relevance:
The findings of this prospective discrete choice experiment indicate that the perceived risk of opioid addiction affects the patient's choice of pain medications after Mohs surgery. It is important to engage patients undergoing Mohs surgery in shared decision-making discussions to determine the optimal pain control plan for each individual. These findings may encourage future research on the risks associated with long-term opioid use after Mohs surgery.
Insights
Patient preferences for pain management after Mohs surgery show a strong inclination towards over-the-counter (OTC) medications, especially when opioid addiction risk is perceived as high. Many patients avoid opioids entirely, prioritizing safety over potential pain relief.
Area of Science:
- Dermatology and Plastic Surgery
- Pain Management and Pharmacology
- Patient-Reported Outcomes
Background:
- Understanding patient preferences for pain management after Mohs micrographic surgery is crucial but understudied.
- Patient choices are influenced by pain levels and perceived risks of opioid addiction.
Purpose of the Study:
- To evaluate patient preferences for pain management using only over-the-counter (OTC) medications versus OTCs plus opioids.
- To assess these preferences across varying theoretical pain levels and opioid addiction risks.
Main Methods:
- A prospective discrete choice experiment was conducted with 295 patients and support persons.
- Participants completed a survey assessing pain medication preferences under different scenarios of pain and addiction risk.
- Data were analyzed using linear interpolation to determine pain thresholds for medication choices.
Main Results:
- 76% of respondents preferred only OTCs over OTCs plus opioids for post-Mohs surgery pain control.
- 34% would never consider opioids, and 50% worried about addiction.
- Only when addiction risk was 0% did half prefer opioids at a pain level of 6.5/10; higher risks led to a preference for OTCs only, even with severe pain.
Conclusions:
- Perceived risk of opioid addiction significantly influences patient choices for pain medication after Mohs surgery.
- Shared decision-making is essential for tailoring pain management plans to individual patient needs and concerns.
- Further research into long-term opioid risks post-Mohs surgery is warranted.
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