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| |  APS: Better Pain Management Needed To Speed Up Recovery Times And Decrease Stress ATLANTA, GA -- November 6, 2000 -- Pain and the side effects of narcotic analgesics prolong recovery times and cause significant distress after ambulatory surgery, according to study results presented at the 19th Annual Scientific Meeting of the American Pain Society on Saturday. Two studies assessed methods and outcomes of post-surgical pain management in 175 adults who underwent common outpatient procedures, including knee arthroscopy, groin hernia repair, pelvic laparoscopy, transvaginal uterine surgery, breast surgery, and plastic surgery. In the first study, which focused on the period after surgery but before discharge, researchers found that the length of stay following outpatient procedures increased significantly with increasing pain severity, time required to treat pain, and total opioid (in this case, fentanyl) dose administered. The second study, which focused on the period after discharge, showed that pain and the side effects of opioids contributed significantly to patient distress, limited activity, and reduced patient satisfaction. "Millions of patients undergo surgery in ambulatory settings every year, and post-operative pain management is especially important in this context, since the goal is to send the patient home as quickly as possible, and in the best possible condition," said D.J. Pavlin, MD, of the University of Washington. "Our data suggest that current pain management procedures and medications may be at odds with this goal." In the study that focused on the pre-discharge period, 20 percent of women and 12.5 percent of men reported severe pain (pain scores = 7 on a scale of 1-10), and greater pain severity was related to longer recovery times. The use of the opioid fentanyl at doses above 125 ?g was associated with significantly longer recovery times compared with doses less than or equal to 125 microgram. Higher doses of fentanyl were associated with a greater incidence of nausea or vomiting, which delayed discharge. A significant proportion of patients -- 24 percent of females and 32 percent of males -- experienced severe pain after returning home from outpatient surgery, according to the post-discharge study. Fewer than half of all patients (49 percent of females, 42 percent of males) were able to return to normal activity within 48 hours. In addition to pain, patients cited nausea, vomiting, constipation, and central nervous system effects such as drowsiness, dizziness, and difficulty concentrating as symptoms causing distress. Pain and side effects also tended to limit patient satisfaction with treatment. "Poorly managed pain can prolong the recovery process," said Dr. Pavlin. "And narcotic analgesic side effects such as nausea and vomiting can interfere with adequate pain control, especially if patients are so ill that they can't hold down oral medications." According to Dr. Pavlin, narcotic analgesics such as fentanyl, morphine, and meperidine also have the potential to cause more serious side effects, such as respiratory depression. In rare instances, such agents have been associated with respiratory arrest, shock, and cardiac arrest. "There has been a long-standing need for safer and better-tolerated acute pain medications. Nowhere is this need more urgent than in outpatient settings," Dr. Pavlin said. One group of medications that may have beneficial applications for surgery is the COX-2 targeted drugs, which effectively relieve pain and inflammation, and are associated with fewer side effects than many other analgesics. For example, compared with narcotics, COX-2 specific inhibitors are much less likely to produce nausea, vomiting, and central nervous system effects (e.g., dizziness and sedation). Oral COX-2 inhibitors have been used to control chronic pain and inflammation associated with arthritis. Parecoxib, the first investigational injectable COX-2 specific inhibitor is currently under evaluation for the management of surgical pain.
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