Complete opioid cessation after surgery improves patient-reported pain measures among chronic opioid users



      Preoperative chronic opioid use is common, but it is unclear whether complete opioid tapering can be achieved postoperatively without adversely affecting pain control and quality of life. This study was designed to assess the association between complete opioid tapering after surgery and patient-reported outcomes for pain intensity and pain interference.


      We identified chronic opioid use patients undergoing a spectrum of nonemergency surgical procedures at a single Veterans Affairs medical institution between December 2017 and 2021. All patients were prospectively followed by a transitional pain service that promoted opioid tapering, assessed opioid use (morphine milligram equivalent), and patient-reported outcomes measurement information system for pain intensity (PROMIS-3a) and pain interference (PROMIS-6b). After stratifying based on whether complete versus partial/no opioid tapering was achieved after surgery, longitudinal changes in patient-reported outcomes and morphine milligram equivalents were compared over time. Independent predictors of complete opioid tapering were assessed using logistic regression models.


      In total, 341 surgical patients (91% male, mean age 64 years) with chronic opioid use underwent surgery during the study period, of which 44 (13%) completely tapered off opioids within 60 days after discharge from the hospital. Patients who completely tapered had significant improvement in the change in patient-reported outcomes for pain intensity and interference with significant differences at 30 and 60 days after discharge for both measures when compared to the partial/no taper group (both P < .05). In risk-adjusted analyses, patients with lower baseline morphine milligram equivalents and those staying longer in the hospital were more likely to achieve complete opioid tapering (both P < .01).


      Complete opioid tapering can be successfully achieved after surgery among patients with chronic opioid use with corresponding improvements in self-reported pain intensity and pain interference. Our results suggest that the highest potential for improving patient-reported outcomes with opioid tapering occurs among patients undergoing orthopedic procedures early after surgical discharge.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hilliard P.E.
        • Waljee J.
        • Moser S.
        • et al.
        Prevalence of preoperative opioid use and characteristics associated with opioid use among patients presenting for surgery.
        JAMA Surg. 2018; 153: 929-937
        • Velazquez-Ramirez G.
        • Krebs J.
        • Stafford J.M.
        • et al.
        Prevalence of chronic opioid use in patients with peripheral arterial disease undergoing revascularization.
        J Vasc Surg. 2022; 75: 186-194
      1. Aneizi A, Gelmann D, Ventimiglia DJ, et al. Preoperative opioid use in patients undergoing common hand surgeries. Hand (N Y). Jan 19 2021:1558944720974122.

        • Nadarajah V.
        • Meredith S.J.
        • Jauregui J.J.
        • et al.
        Preoperative opioid use in patients undergoing shoulder surgery.
        Shoulder Elbow. 2021; 13: 248-259
        • Ravi B.
        • Pincus D.
        • Croxford R.
        • et al.
        Patterns of pre-operative opioid use affect the risk for complications after total joint replacement.
        Sci Rep. 2021; 11: 22124
        • Wilson J.M.
        • Farley K.X.
        • Gottschalk M.B.
        • Daly C.A.
        • Wagner E.R.
        Preoperative opioid use is an independent risk factor for complication, revision, and increased health care utilization following primary total shoulder arthroplasty.
        J Shoulder Elbow Surg. 2021; 30: 1025-1033
        • Kim N.S.
        • Lam A.W.
        • Golub I.J.
        • et al.
        Opioid use disorder in patients undergoing primary 1- to 2-level anterior cervical discectomy and fusion is associated with longer in-hospital lengths of stay and higher rates of readmissions, complications, and costs of care.
        Global Spine J. Aug. 2021; 1921925682211037265
        • Kim S.C.
        • Jin Y.
        • Lee Y.C.
        • et al.
        Association of preoperative opioid use with mortality and short-term safety outcomes after total knee replacement.
        JAMA Netw Open. 2019; 2e198061
        • Sigurdsson M.I.
        • Helgadottir S.
        • Long T.E.
        • et al.
        Association between preoperative opioid and benzodiazepine prescription patterns and mortality after noncardiac surgery.
        JAMA Surg. 2019; 154e191652
        • Buys M.J.
        • Bayless K.
        • Romesser J.
        • et al.
        Multidisciplinary transitional pain service for the veteran population.
        Fed Pract. 2020; 37: 472-478
        • Buys M.J.
        • Bayless K.
        • Romesser J.
        • et al.
        Opioid use among veterans undergoing major joint surgery managed by a multidisciplinary transitional pain service.
        Reg Anesth Pain Med. 2020; 45: 847-852
        • Uhrbrand P.
        • Rasmussen M.M.
        • Haroutounian S.
        • Nikolajsen L.
        Shared decision-making approach to taper postoperative opioids in spine surgery patients with preoperative opioid use: a randomized controlled trial.
        Pain. 2022; 163: e634-e641
        • Frank J.W.
        • Levy C.
        • Matlock D.D.
        • et al.
        Patients’ perspectives on tapering of chronic opioid therapy: a qualitative study.
        Pain Med. 2016; 17: 1838-1847
        • Ghaferi A.A.
        • Schwartz T.A.
        • Pawlik T.M.
        STROBE reporting guidelines for observational studies.
        JAMA Surg. 2021; 156: 577-578
        • Amtmann D.
        • Kim J.
        • Chung H.
        • Askew R.L.
        • Park R.
        • Cook K.F.
        Minimally important differences for patient reported outcomes measurement information system pain interference for individuals with back pain.
        J Pain Res. 2016; 9: 251-255
        • Steinhaus M.E.
        • Iyer S.
        • Lovecchio F.
        • et al.
        Minimal clinically important difference and substantial clinical benefit using PROMIS CAT in cervical spine surgery.
        Clin Spine Surg. 2019; 32: 392-397
        • Goesling J.
        • Moser S.E.
        • Zaidi B.
        • et al.
        Trends and predictors of opioid use after total knee and total hip arthroplasty.
        Pain. 2016; 157: 1259-1265
        • Hah J.M.
        • Trafton J.A.
        • Narasimhan B.
        • et al.
        Efficacy of motivational-interviewing and guided opioid tapering support for patients undergoing orthopedic surgery (MI-Opioid Taper): a prospective, assessor-blind, randomized controlled pilot trial.
        EClinicalMedicine. 2020; 28: 100596
        • Brown C.S.
        • Vu J.V.
        • Howard R.A.
        • et al.
        Assessment of a quality improvement intervention to decrease opioid prescribing in a regional health system.
        BMJ Qual Saf. 2021; 30: 251-259
        • Agarwal A.K.
        • Lee D.
        • Ali Z.
        • et al.
        Patient-reported opioid consumption and pain intensity after common orthopedic and urologic surgical procedures with use of an automated text messaging system.
        JAMA Netw Open. 2021; 4e213243
        • Uhrbrand P.
        • Phillipsen A.
        • Dreyer P.
        • Nikolajsen L.
        Opioid tapering after surgery: a qualitative study of patients’ experiences.
        Scand J Pain. 2020; 20: 555-563
        • Henry S.G.
        • Paterniti D.A.
        • Feng B.
        • et al.
        Patients’ experience with opioid tapering: a conceptual model with recommendations for clinicians.
        J Pain. 2019; 20: 181-191