Stop Making Surgeons Undertreat Postoperative Pain

#An opinion piece by ACSH advisor Dr. Jeffery Singer and Dr. Josh Bloom entitled "Stop Making Surgeons Undertreat Postoperative Pain" was published in the latest issue of General Surgery News. The first three paragraphs (below) are reprinted with permission. The remainder of the article can be found here.

Indisputable evidence shows the absence of a correlation between the number of opioid prescriptions and opioid abuse or addiction. This has not, however, dissuaded practicing physicians from buying into the false narrative that prescribing opioids for pain is fueling the overdose crisis.

According to statistics from the CDC, the number of all opioid prescriptions dropped roughly 42% from 2012 to 2019, a year when overdose deaths hit a new peak of 71,327. The top four implicated drugs—illicit fentanyl and its analogs, heroin, cocaine and methamphetamine—were involved in far more deaths than any prescription opioid. Yet surgeons are repeatedly encouraged to use IV acetaminophen—which is simply Tylenol—to treat postoperative pain in order to spare their patients the risk for addiction.

The literature is jam-packed with studies about the effect, or lack thereof, of IV Tylenol in controlling pain from a variety of surgical procedures. But virtually all of these are retrospective studies, which are inferior to controlled prospective studies with predetermined endpoints and a control group (usually placebo). Now there’s a randomized, double-blind, placebo-controlled trial—the gold standard of clinical trials—and if this doesn’t disabuse doctors from prescribing acetaminophen for postoperative pain, nothing will. Lead author Alparslan Turan, MD, and colleagues published the results in JAMA last July (2020;324[4]:350-358) and it was recently summarized in General Surgery News.