ALEXANDRIA, VA — The American Academy of Otolaryngology‒Head and Neck Surgery Foundation published the Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations today in Otolaryngology–Head and Neck Surgery. This specialty-specific guideline provides evidence-based recommendations on postoperative management for pain in common otolaryngologic procedures, with a focus on opioids.
As otolaryngologist-head and neck surgeons, we can help reduce the risk of opioid use disorder among our patients and their families. This clinical practice guideline focuses on multimodal analgesia and judicious use of opioids for common otolaryngology procedures.
Samantha Anne, MD, MS (Chair of the Guideline Development Group)
Opioid use disorder (OUD), which includes misuse, abuse, and overdose of opioids, is an epidemic in the United States. According to data from the National Survey on Drug Use and Health, more than six million people ages 12 or older misuse prescription pain relievers in a given year in the United States. Additionally, studies have shown that there is a significant risk of chronic opioid use even when used as short-term treatment for pain.
The guideline addresses assessment of patients for OUD risk factors, counseling on pain expectations, and identifying factors that can affect pain duration and/or severity. It also discusses the use of multimodal analgesia as first-line treatment and responsible use of opioids. In addition, the guideline highlights quality improvement opportunities in postoperative pain management of common otolaryngologic surgeries. Employing the key action statements from this clinical practice guideline (CPG) can help to reduce the variation in care across the specialty of otolaryngology and improve postoperative pain control while reducing the risk of OUD.
“Many times, opioids are prescribed in excessive quantities for procedures that are associated with mild-to-moderate pain, such as parathyroidectomy, thyroidectomy, and otologic surgeries. The number of opioids prescribed for these procedures can be reduced, especially if appropriate multimodal analgesia is used,” says Dr. Anne. “The guideline also emphasizes the importance of counseling patients and identifying patient- and procedure-related factors that can inform shared decision-making.”
The CPG is intended for otolaryngologists who perform surgery and clinicians who manage pain after surgical procedures. The target patients for the guideline are any patients treated for anticipated or reported pain within the first 30 days after undergoing common otolaryngologic procedures.
Members of the media who wish to obtain a copy of the guideline or request an interview should contact Tina Maggio at [email protected]. Upon release, the guideline and other supplemental materials can be found at www.entnet.org/opioidscpg.
1. What are some common words used in terms of pain management and opioids?
Analgesia is the absence or reduction of pain in response to something that would normally be painful. There are different ways to help patients achieve analgesia after surgery.
In this guideline, the ‘‘postoperative period’’ is the period of patient recovery up to 30 days after a surgical procedure. To achieve analgesia after surgery in this postoperative period, healthcare providers may use different types of medications.
Opioids are medications that interact with opioid receptors on nerve cells and are used to treat moderate to severe pain. They are legally available for healthcare provides to prescribe as synthetic opioids, such as fentanyl, or prescription pain relievers, such as oxycodone, hydrocodone, and others.
2. Why is this guideline important?
The evidence-informed recommendations within this guideline aim to help reduce the risk of opioid use disorder and the variation in care across the specialty of otolaryngology.
3. What is the incidence of opioid use disorder?
The prevalence of prescription opioid misuse was surveyed at 3.6% (11.5 million persons) of the U.S. population in 2018, according to the 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes from the Centers for Disease Control and Prevention (CDC). That same report from the CDC in 2019 estimates that 56 million persons (17.4 % of the U.S. population) filled at least one opioid prescription in 2017 and the average days of supply per prescription filled increased from 13.3 in 2006 to 18.4 days in 2018.
4. What can providers do to reduce opioid use disorder?
The CPG includes an algorithm of the guideline action statements as a supplement to clinicians. The algorithm allows for a more rapid understanding of the guideline’s logic and sequence of action statements – to be adopted as a quick-reference guide to support the implementation of the guideline’s recommendations.
Providers can assess patients for opioid use disorder risk factors, counsel patients on pain expectations, promote shared decision making, and identify factors that can affect pain duration and/or severity after operations. As well, providers can choose multimodal analgesia as the first-line treatment for pain, use opioids judiciously for pain management, communicate with patients about stopping all analgesics when pain has resolved, and counsel patients and caregivers to store opioids securely and safely dispose of unused opioids.
Visit www.entnet.org/opioidscpg for more information.