1. Boscarino JA, Rukstalis M, Hoffman SN, et al. Risk factors for drug
dependence among out-patients on opioid therapy in a large U.S.
health care system. Addiction. 2010; 105( 10):1776-1782.
2. Banta-Green CJ, Merrill JO, Doyle SR, Boudreau DM, Calsyn DA.
Opioid use behaviors, mental health and pain—development of a
typology of chronic pain patients. Drug Alcohol Depend. 2009; 104( 1-2):34-
42.
3. Zuccaro SM, Vellucci R, Sarzi-Puttini P, Cherubino P, Labianca R,
Fornasari D. Barriers to pain management: Focus on opioid therapy.
Clin Drug Investig. 2012; 32 (Suppl 1): 11-19.
4. Waljee JF, Li L, Brummett CM, Englesbe MJ. Iatrogenic opioid
dependence in the United States: Are surgeons the gatekeepers? Ann
Surg. 2017;265( 4):728-730.
5. Olsen Y. The CDC guideline on opioid prescribing: Rising to the
challenge. JAMA. 2016;315( 15):1577-1579.
6. Angioli R, Plotti F, Capriglione S, et al. The effects of giving patients
verbal or written pre-operative information in gynecologic oncology
surgery: A randomized study and the medical-legal point of view. Eur J
Obstet Gynecol Reprod Biol. 2014;177: 67-71.
7. Kruzik N. Benefits of preoperative education for adult elective surgery
patients. AORN J. 2009; 90( 3):381-387.
8. Nielsen S, Campbell G, Peacock A, et al. Health service utilisation by
people living with chronic non-cancer pain: Findings from the Pain
and Opioids IN Treatment (POIN T) study. Aust Health Rev. 2015; 40( 5)
490-499.
9. Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of
postoperative pain: A clinical practice guideline from the American
Pain Society, the American Society of Regional Anesthesia and Pain
Medicine, and the American Society of Anesthesiologists’ Committee
on Regional Anesthesia, Executive Committee, and Administrative
Council. J Pain. 2016; 17( 2):131-157.
10. Gawande AA. It’s time to adopt electronic prescriptions for opioids.
Ann Surg. 2017;265( 4):693-694.
11. Hill MV, McMahon ML, Stucke RS, Barth RJ Jr. Wide variation and
excessive dosage of opioid prescriptions for common general surgical
procedures. Ann Surg. 2017;265( 4):709-714.
12. Vadivelu N, Kai AM, Kodumudi V, Zhu R, Hines R. Pain management
of patients with substance abuse in the ambulatory setting. Curr Pain
Headache Rep. 2017; 21( 2): 9.
13. Wilson M, Roll JM, Corbett C, Barbosa-Leiker C. Empowering
patients with persistent pain using an Internet-based self-management
program. Pain Manag Nurs. 2015; 16( 4):503-514.
14. Gordon DB, de Leon-Casasola OA, Wu CL, Sluka KA, Brennan TJ,
Chou R. Research gaps in practice guidelines for acute postoperative
pain management in adults: Findings from a review of the evidence
for an American Pain Society Clinical Practice guideline. J Pain.
2016; 17( 2):158-166.
are seen in patients with underlying psychiatric disorders and chronic functional
abdominal pain syndromes.
29 Although
the literature regarding operative pain
control in this population is scarce, it is
reasonable to assume that, as in other
subsets of chronic pain patients, postoperative pain control and opioid withdrawal
may be challenging, and adverse effects
can be mitigated through proper assessment and counseling. The surgeon should
be diligent and educate the patient both
preoperatively to discuss realistic expectations of postoperative symptoms, as
well as prior to discharge to discuss the
following: weaning the patient off of opioids; managing opioid use; caring for
unpredictable gastrointestinal function
frequently encountered with IBD; and
how to contact their provider if problems
arise in the outpatient setting. Postoperative opioid use should also be discussed at
follow-up appointments and may involve
a joint approach between the surgeon and
gastroenterologist.
Tools of the trade and
patient resources
Making patient educational tools and information available in patient waiting rooms
and the office setting can provide an icebreaker to start the conversation about
opioids. It is ideal to include culturally sensitive, inclusive images in these materials, as
well as figures and text that are easy to comprehend. Table 1, page 18, is an example of
a basic chart with commonly used opioids
that physicians can use to develop a pain
management plan with a patient.
Implementation of a system-wide initiative within the U.S. Department of
Veterans Affairs (VA) has been associated
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