Association of patient-reported substance use and postoperative pain

Substance use among surgical patients is common and correlated with greater postoperative opioid use. However, the association of preoperative substance use on postoperative pain is unknown. In this context, a brief, validated tool such as the Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) Questionnaire could provide valuable information to assess the risk of poor postoperative pain control.

We prospectively identified adults aged 18 years and older undergoing common surgical procedures between December 2018 and July 2023 across three institutions. Patients completed the TAPS measure prior to surgery. A positive TAPS screen was defined as tobacco use ≥monthly, heavy alcohol use ≥monthly, any use of recreational drugs, or any use of prescription medication not as prescribed. The primary outcome was 'worst' overall pain (on a scale of 0-10, 0=no pain, 10=worst pain imaginable) at three time points: prior to surgery, 2 weeks postoperatively, and 1 month postoperatively. Mixed linear models were used to determine the association between TAPS Score and pain over time, adjusting for patient factors.

In this cohort of 4410 individuals, 42.2% reported unhealthy substance use using TAPS in the 12 months prior to surgery. After adjusting for patient factors, participants who screened positively on TAPS reported higher worst overall pain scores than those with negative TAPS screens at baseline (3.51 vs 3.15, p<0.001) and at 1 month postoperatively (2.66 vs 2.41, p=0.036). No significant difference was observed at 2 weeks after surgery.

Preoperative substance use is common and is correlated with higher levels of patient-reported pain after surgery, but within minimal clinically important differences. These findings are preliminary and require confirmation. Risky substance use has an important impact on postoperative recovery, and the perioperative window provides an opportunity to assess and intervene in unhealthy substance use.