SVS – Patients with artery disease are taking more painkillers, but reasons are complex

PR Newswire

ROSEMONT, Ill., Oct. 30, 2019 /PRNewswire/ -- A large new study has found that an artery disease that mostly affects legs and feet is associated with increased use of opioids, the Society for Vascular Surgery reports. Researchers discovered that some patients who had a procedure to improve pain from poor circulation actually increased their use of opioids after treatment.

By the time they meet their vascular surgeon, more than a quarter of patients with leg artery disease are already using opioids for back pain or another problem.

Reported in the October 2019 edition of the Journal of Vascular Surgery, the study looked at 178,880 de-identified patients in a private, health insurance data base over an eight-year period who were found to have PAD, or peripheral arterial disease. Over a third of them had painful, advanced cases, called chronic limb ischemia (CLI). [Listen to medical professionals discuss these findings. 5:09]

"The first thing that surprised us," said lead author Dr. Nathan K. Itoga, "is that a significant number of PAD and CLI patients were already on opioids when they had their first PAD diagnosis. After they were diagnosed with either condition, the percentage receiving opioids went up and it also went up after they had a procedure to address their disease."

His team found that high opioid use increased from 25.8% in the years before treatment to 29.6% in the years after treatment. For patients without CLI, high opioid use increased from 22.7% before treatment to 25.9% after treatment and from 30.8% before treatment to 37.1% after treatment for patients with CLI.

PAD occurs when plaque builds up in arteries and make it harder for oxygen-rich blood to get to all parts of the body. When it diminishes blood flow to the legs and feet, it's called PAD. When it starts causing open sores on the feet, and/or gangrene, it's called CLI, and can lead to amputations in some cases.

The study found that high-opioid use patients were more likely to have back and neck pain, be smokers and/or have depression. High opioid use was defined in the study as patients who were prescribed two or more opioid prescriptions in a year.

The study did not determine where the additional opioids came from, he said, "but having PAD would not be a routine reason for a physician to prescribe opioids, unless the patient has resting pain or open wounds."

It's possible, he theorized, that higher opioid use after surgery is akin to a prescription side effect for a small percentage of patients in chronic pain.

Meanwhile, physicians are prescribing with more caution and the Society for Vascular Surgery supports assuring that physicians maintain the ability to prescribe what is best for their patients without regulatory interference.

"Before this research and the opioid crisis," Dr. Itoga said, "I would have sent a patient home from open surgery with perhaps 60 pills. Now I prescribe 10 to 15 pills. And previously, for someone who had an endovascular procedure, I used to send them home with opioids in case they needed them. Now I tell them to take over-the-counter medication if they need it."

He pointed out that the pain from PAD is real. Early on, patients may have a cramping sensation called claudication, which mostly occurs while walking. If the disease progresses untreated, painful open sores on the feet can occur, and if PAD leads to chronic limb ischemia and amputation, that post-operative pain needs strong medication management.

"It's a tough decision for physicians," Dr. Itoga said. "The patients are in pain and suffering you don't want to ignore it, but you don't want them to become addicted. We just want to make people aware."

The Society for Vascular Surgery® (SVS) is a not-for-profit professional medical society, composed of specialty-trained vascular surgeons and professionals, which seeks to advance excellence and innovation in vascular health through education, advocacy, research and public awareness.

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