Educating Patients Regarding Pain Management and Safe Opioid Use After Surgery

A Narrative Review

Bradley H. Lee, MD; Christopher L. Wu, MD


Anesth Analg. 2020;130(3):574-581. 

In This Article

Influence of Education on Postoperative Pain and Opioid use

There is evidence that preoperative counseling and education can shape patients' expectations, attitudes, and behaviors related to opioid use. In a study by Sugai et al,[8] patients undergoing ambulatory surgery were randomly assigned to education sessions 2 weeks before their procedure. They were given both oral and written information focusing on the negative side effects of opioids, role of exogenous opioid in the processing of pain, and importance of nonopioid analgesics. Patients who received this education were less likely to request opioids postoperatively while actually reporting lower average pain scores and shorter duration of pain.[8]

Informing patients about opioid use and managing postoperative pain may reduce opioid consumption after surgery. Holman et al[9] investigated this in orthopedic trauma patients who were given preoperative counseling that included the following points: (1) acknowledging that discomfort is associated with injury, (2) reduction of discomfort is a priority for caregivers, (3) pain may be reduced but not eliminated, and (4) oral opioids are part of treatment but come with risks including side effects, physical dependence, and withdrawal symptoms. Patients who received counseling were more likely to stop opioid use by the 6-week mark compared with those who had not received any counseling.[9] In another study, a preoperative educational program consisting of a video and handout detailing opioid side effects, dependence, and addiction led to earlier opioid cessation and less overall use in patients who underwent rotator cuff repair.[10] Last, in a study by Yajnik et al,[11] a reference card describing the patient's multimodal analgesic regimen was reviewed both preoperatively and postoperatively in patients undergoing total knee replacement. The use of the reference card resulted in significantly less opioid consumption which may reflect the influence of education and multimodal analgesia.[11]

Educating patients about safe practices when taking opioids may reduce risky behaviors associated with opioid use. In evaluating emergency department patients who received both written and verbal instructions after being prescribed Norco (hydrocodone and acetaminophen), McCarthy et al[12] found that instructions led to improved knowledge of medication side effects. Patients were also more likely to remember precautions about taking additional acetaminophen while taking Norco (hydrocodone and acetaminophen).[12] Furthermore, patients who received the intervention were less likely to report having driven a vehicle within 6 hours after taking the opioid.[12] Increasing knowledge about dangers of addiction and abuse may lead to safer patient practices with opioid management. In patients using opioids for longer durations, there is evidence that those who are informed regarding the risks of addiction reported lower rates of pill saving.[7]

Emphasizing safe storage and disposal of opioids can improve proper handling. de la Cruz et al[13] demonstrated this using a combined written and in-person educational intervention. Patients received educational material consisting of a 2-page handout written for comprehension at an eighth-grade level of education. In addition, clinic staff including nurses, pharmacists, and physicians were given in-service training about safe practices, and each patient was provided information by staff members who reviewed general points in the educational material and answered questions.[13] Educational material provided to patients regarding safe use, storage, and disposal of opioids led to greater awareness of proper disposal methods, and those who received education were less likely to report having unused medications at home.[13] Other studies have also demonstrated improved rates of proper opioid disposal with educational interventions.[14,15]

Preoperative education has not consistently demonstrated effects on anxiety, pain perception, or length of stay after surgery.[16–20] Some studies show a positive effect of education on postoperative pain control,[21,22] while others do not.[19] The emphasis and priority with patient education are primarily to improve knowledge using concepts of early education, repetition, and reinforcement.[16,23] The subjective experience and perception of pain may not necessarily change with education; however, providing patients with practical information about using opioids to manage pain will improve their knowledge. The objective is for this knowledge to shape patients' attitudes and behaviors related to opioid use resulting in safer practices.