Researchers at Brigham and Women’s Hospital in Boston say that when it comes to prescribing pain relief following a cesarean delivery, shared decision-making is crucial.
In a survey, the researchers found that opioids may be overprescribed to women who have had cesarean deliveries. And in a second, related study, it was found that patients would prefer to be prescribed less medication.
“It’s of interest because cesarean delivery is the most common inpatient surgical procedure in the United States, and almost all patients in the U.S. receive a prescription for an opioid medication after cesarean delivery,” Dr. Brian Bateman, chief of Obstetric Anesthesia at Brigham and Women’s Hospital, and corresponding author of the two papers, told Healthline.
In the first study, 720 women from six academic medical centers in the United States were surveyed on what they were prescribed following a cesarean delivery. Ninety-five percent of the women surveyed reported they had not thrown out their excess medication two weeks after being discharged from the hospital.
The second study dealt with a shared decision-making tool. The tablet-based tool allowed study participants to make an informed decision, along with a clinician, on how many pills they’d like to be prescribed. It was found that the shared decision-making tool caused the number of opioid pills prescribed to be cut in half.
Bateman says that these insights could lead to a different way of writing prescriptions for women who’ve had cesarean deliveries.
An opioid crisis
Bateman told Healthline that he and his colleagues decided to embark on the studies after seeing a wide degree of variability in the way opioids were being prescribed. This led the research team to ask the question of what exactly constitutes an appropriate prescription, as well as how much patients are actually taking of the opioids they’ve been prescribed.
“In most countries outside of the U.S., opioids are not necessarily prescribed following cesarean delivery,” he said. “In many countries, the standard approach after discharge is to treat pain with nonsteroidal anti-inflammatory medications or acetaminophen. I think the U.S. stands out in terms of routinely prescribing opioids.”
“Across all of clinical medicine, opioids are more widely used in the U.S. compared with other countries. It’s just something about the way medicine has developed over the last couple of decades in the U.S. This country certainly uses far more than its fair share of opioids.”
Several important findings
The research led to some significant takeaways for Bateman’s research team.
The first finding was that the amount of opioids that are prescribed doesn’t match well with what patients actually consume. With patients only consuming half of what they’ve been dispensed on average, this means that there’s a large amount of leftover medications — leading to the potential for misuse or diversion.
Researchers also noted that, the more patients were prescribed, the more opiates they would take, regardless of their characteristics or pain scores.
“I think this really suggests that as physicians, we set patients’ expectations as to how much they should be taking by the amount that we prescribe,” said Bateman. “If we prescribe a very large amount of opioids, patients assume they’re supposed to take a large amount, and if we prescribe a smaller amount, patients assume they’re supposed to take smaller amounts.”
It’s also worth noting that patients who were prescribed more opioids didn’t see a difference in pain scores vs. those who’d been prescribed less. In fact, patients who took high dosages experienced more opioid-related side effects.
“This data suggests, really, that prescribing more leads to taking more, but it doesn’t improve either patient satisfaction or pain scores,” Bateman told Healthline. “But it does lead to a higher rate of some of the adverse effects that are associated with opioids.
The findings from the shared decision-making study suggest that patients don’t necessarily want to be prescribed large amounts of opioids.
“We found that when we gave patients information about what other patients like them typically consumed, the risks and benefits of opioids, and the expected trajectory of the resolution of their pain symptoms, patients chose to be prescribed, on average, about half of the total opioid prescription,” said Bateman.
Bateman says he and his colleagues are interested in further exploring the shared decision-making approach.
To that end, Bateman says, he’d like to further test and refine this approach. He told Healthline, “It’s potentially a really important way of better aligning what patients are prescribed vs. what they actually use, and so we want to refine this and find ways of scaling it in cesarean delivery.”