AUSTIN, Texas - A newly standardized pain treatment plan for pregnant women delivering in hospitals reduced mothers' opioid use before and after delivery and may reduce their risk of opioid addiction later, according to a study published in the latest issue of Obstetrics & Gynecology.
The study of 14,419 women delivering in Central Texas hospitals showed that the chances of receiving an opioid for pain control after giving birth vaginally decreased by 26%. Among those experiencing cesarean birth, the risk dropped 18%. For new moms who did receive opioids, the amount of opioids they received declined 30% with the new pain protocol.
"Over these last two decades opioid use among women increased dramatically in the U.S., and overprescribing is at the heart of the problem," said Rebecca G. Rogers, M.D., the study's lead author, associate chair of clinical integration and operations, and professor in the Department of Women's Health at Dell Medical School at The University of Texas at Austin. The study was conducted in collaboration with Ascension Seton.
The number of women who died from prescription opioid overdose more than quadrupled between 1999 and 2010, according to the Centers for Disease Control and Prevention.
"This revised pain protocol means that we are able to target a common instance in which women are often prescribed opioids, and be much more judicious about when an opioid is actually necessary," Rogers said. The study adds to previous research in this area, which has focused on reducing opioid use after cesarean deliveries, but did not address vaginal deliveries, which comprise two-thirds of all births, she added.
The current study compared women who gave birth at five Ascension Seton hospitals in Central Texas between April 1, 2016, and Feb. 28, 2018 - 10 months before and 12 months after the new pain plan was implemented.
Pain relief medications, including opioids, tend to be prescribed according to how pregnant and postpartum women assess their own pain, usually on a scale of 1 to 10. Previously, new mothers stating their pain level was 4 or higher were likely to be given opioids.
The new approach rests more on how well the women function - for example, if they can use the restroom or rest comfortably, even if they continue to experience some pain. This allows for pain to be treated instead with nonopioid prescriptions or over-the-counter pain relievers such as acetaminophen, ibuprofen or naproxen.
"Opioids are powerful drugs that decrease pain, but they can also lead to addiction and deadly overdoses if not taken with care," Rogers said. "Recent evidence has shown that even one exposure to opioids could lead to long-term dependence and that many women do just as well with nonopioid medications."
If you are a mother who needs opioids after delivery, it is important to talk to your physician about how to use them safely, she said. But Rogers warned, "Even with opioids, you may still experience pain, but your doctor will work with you to make sure you are able to rest and move comfortably."
She hopes the study's findings encourage other clinicians to create similar pain plans designed to reduce opioid usage. Looking ahead, Rogers hopes further research will determine whether standardized pain plans can reduce outpatient opioid prescriptions and, ultimately, opioid abuse among other kinds of patients.
Meanwhile, the research team will continue to monitor opioid use by mothers in the five hospitals involved in the study until they and their babies can safely go home.
Other researchers involved in the study were Michael Breen, M.D.; Patrick Chang, M.S., MPH; Zachary Chipman, M.D.; Chad Dieterichs, M.D.; Stephanie Nutt, M.A., MPA; Jamie Moxham, MSPH; Michael Nix, M.D.; Paul J. Rathouz, Ph.D.; Henry Robertson, Ph.D.; and Amy Young, M.D.
