Table 3 Overview of the findings of included systematic reviews. This table summarised the findings of included systematic review. The main findings, meta-analysis and effect size (if reported) and degree of certainty of each review are all stated. In addition, the priorities of the Levy et al. and Forget et al. consensuses that the reviews relate to have been reported [2, 8]
Authors | Main findings | Meta-analysis (yes/no) | Effect size with [95% confidence interval] | Degree of certainty | Priority |
|---|---|---|---|---|---|
Albrecht et al | There is low certainty of evidence that high-dose intraoperative opioid administration increases pain scores in the post-operative period when compared with a low-dose regimen | Yes | Mean difference: -0.22 [-0.39, -0.05] | Low | Forget et al. 4 |
Arwi & Schug | The current discharge opioid prescribing practices can be improved. Lack of patient education regarding storage and disposal of opioids also contributes to the increasing rate of opioid misuse, diversion, and unintended long-term use. More high-quality research with comparable outcomes is needed. Evidence-based hospital guidelines and public health policies are needed to improve opioid stewardship | No | Not reported | Good – poor | Levy et al. 6 + 10 |
Baamer et al | This review found no evidence that any one unidimensional tool has superior measurement properties in assessing postoperative pain. In addition, because promoting function is a crucial perioperative goal, psychometric validation studies of functional pain assessment tools are needed to improve pain assessment and management | No | Not applicable | High – very low | Levy et al. 3 |
Bicket et al | Post-operative prescription opioids often go unused, unlocked, and undisposed, suggesting an important reservoir of opioids contributing to non-medical use of these products | No | Not reported | Intermediate | Levy et al. 10 |
Feinberg et al | Surgical patients are using substantially less opioids that prescribed. There is a lack of awareness regarding proper disposal of leftover medication, leaving excess opioids that may be used inappropriately by the patient or others. Education for providers and clinical practice guidelines that provide guidance on prescription of outpatient of opioids are required | No | Not reported | Not reported | Levy et al. 6 |
Horn et al | By addressing the psychological needs of patients through preoperative education, one can decrease postoperative recovery time and postsurgical acute pain. Reduced postsurgical acute pain results in fewer opioid prescriptions, which theoretically lowers the patient’s risk of developing chronic postsurgical pain, and potentially offers a novel concept using pre-emptive pain psychoeducation as a part of multimodal pain management solution to the opioid epidemic | No | Not reported | 1a – 3b | Levy et al. 2 |
Lamplot et al | Opioid pain medications are overprescribed postoperatively, and baseline rates of surplus opioid disposal are low. While it remains unclear whether patient education alone increases rates of safe opioid disposal, drug disposal kits or bags do appear to significantly increase these rates | No | Not reported | Acceptable | Levy et al. 10 |
Lawal et a | In this study, preoperative use of opioids and cocaine and the presence of comorbid pain conditions before surgery had the strongest associations with prolonged opioid use after surgery. These largely modifiable patient-level risk factors may be included as part of a comprehensive strategy to screen for at-risk individuals requiring transition to non-opioid interventions after surgery while ensuring appropriate short-term opioid use to manage postoperative pain. Research is needed to further investigate the association between surgical pain and prolonged opioid use after surgery | Yes | Not applicable | High | Levy et al. 1 |
Martinez et al | A combination of acetaminophen with either an NSAID or nefopam was superior to most non-morphine analgesic used alone, in reducing morphine consumption. Efficacy was best with three non-morphine analgesic used alone (α-2 agonists, NSAIDs and COX-2 inhibitors) and least with tramadol and acetaminophen. There is insufficient trial data reporting adverse events | No | Morphine consumption: -1 [-83 to 6.3] to -23.9 [-40.1 to -7.7] Pain: 0.8 [-14.9 to 16.5] to -12.4 [-21 to -3.8] | High – low and unclear risk of bias | Levy et al. 4 |
Powell et al | The evidence suggested that psychological preparation may be beneficial for the outcomes postoperative pain, behavioural recovery, negative affect and length of stay, and is unlikely to be harmful. However, at present, the strength of evidence is insufficient to reach firm conclusions on the role of psychological preparation for surgery. Further analyses are needed to explore the heterogeneity in the data, to identify more specifically when intervention techniques are of benefit. As the current evidence quality is low or very low, there is a need for well‐conducted and clearly reported research | Yes | Not reported | Low – very risk of bias | Levy et al. 2 |
Sobol-Kwapinska et al | Significant preoperative psychological correlates of acute postsurgical pain were the following: pain catastrophizing, expectation of pain, anxiety (state and trait), depression, optimism, negative affect and neuroticism/psychological vulnerability. Results of meta-analyses suggested that pain catastrophizing was most strongly associated with acute postsurgical pain. It must be noted that the expression ‘the most common/frequent correlates’ should not be confused with the ‘most important correlates’ | Yes | Correlation: r = 0.24 [0.11 to 0.36] to 0.41 [0.28 to 0.52] | Moderate – low risk of bias | Levy et al. 2 |
Wetzel et al | In this systematic review, interventions operating at a physician or organizational level (e.g., workflow changes) have shown positive results, while interventions at the patient level (e.g., patient education) have shown mixed results. Monitoring for negative consequences was key across the studies evaluated. The studies reviewed provide evidence that clinician-mediated and organizational-level interventions are powerful tools in creating change in postsurgical opioid prescribing. This summary highlights paucity of high-quality studies that provide clear evidence on the most effective intervention at reducing postoperative opioid prescribing | No | Not reported | Low | Forget et al. 1 |