In a study, the Society for Vascular Surgery has shown why Peripheral Artery Disease (PAD) is associated with the increased use of opioids – painkillers. The findings of the study are presented in the “Journal of Vascular Surgery” in the October 2019 edition.
PAD patients and the use of opioids
The researchers found that PAD patients who had a procedure to reduce pain from poor circulation had increased their use of painkillers after treatment. PAD is a disease of arteries that mostly affects legs and feet. It occurs due to the build-up of plaque in arteries. That makes it harder to supply oxygen-rich blood to all parts of the body.
When the plaque diminishes the blood flow to legs and feet, the condition is called peripheral artery disease or PAD. But when it starts causing gangrene, or/and open sores on the feet, it is called chronic limb ischemia (CLI). That can even lead to amputations in some patients.
This study has observed nearly 178,880 de-identified patients with PAD in a private, health insurance database for over eight years. While, among these patients, more than one-third had painful and advanced cases, called CLI.
Dr. Nathan K. Itoga is the lead author of the study. According to him, the most surprising thing they found was that a notable number of CLI and PAD patients were already taking opioids at the time of their first PAD diagnosis.
The percentage of patients receiving opioids went up after the diagnosis with either condition. Moreover, an increase in percentage was also observed after the patients had a procedure to address their disease. The research team found that the use of opioids was 25.8% in the years before treatment. But it increased to 29.6% after the treatment.
For patients without CLI, there was an increase in the use of opioids from 22.7% before treatment to 25.9% after treatment. On the contrary, the increase was from 30.8% to 37.1% for patients with CLI.
Physicians prescribe what’s best for their patients
The study found that patients with high-opioid use were more likely to be smokers, have neck and back pain, or/and depression. Whereas, the high-opioid use in the study is described as the patients who were prescribed two or more opioid prescriptions per year.
The study is uncertain about where the additional opioids came from. But according to Dr. Itoga having PAD will not be a routine reason for a physician to suggest opioids unless the patient has a continuous pain or open wounds.
He hypothesized that increased opioid use after surgery may be affiliated to a prescription side effect for a small number of patients in chronic pain. However, the physicians are prescribing these painkillers with more caution.
The Society for Vascular Surgery assures that physicians can prescribe what is best for patients without regulatory interference. Dr. Itoga said that before this study and opioid crisis, he would have sent a patient home after open surgery with almost 60 pills. But now he prescribes 10 to 15 pills.
Moreover, previously for someone with the endovascular procedure, he used to prescribe them with opioids in case they needed them. Now, on the contrary, he suggests them to use the over-the-counter medication if they need it. He stated that the pain experienced due to PAD is real.
Firstly, the patients may have a cramping sensation, that mostly occurs while walking. But if the disease is left untreated, it can lead to painful open sores on the feet. That can further cause chronic limb ischemia and amputation, in case of which post-operative pain requires strong medication management.
Prescribing opioids is a tough decision for any physician, Dr. Itoga said. The patients are suffering from pain you don’t want to ignore it but also don’t desire for them to become addicted.