Plastic surgeons are prescribing more than double the painkillers that the average patient needs after a nose job, according to a new study.
In a small study led by a plastic surgery practice in San Antonio, Texas, researchers found that 74 percent of patients needed no more than 15 out of the 20-30 hydrocodone tablets they were prescribed to manage post-operative pain.
The opioid epidemic killed more than 64,000 Americans last year, and in March the CDC reported that a 31-day prescription increases the risk of addiction by about 30 percent.
The study authors write in the Journal of the American Medical Association that their findings are a ‘call to action’ for prescribers to be ‘steadfast in prescribing an appropriate amount of pain medication after surgery.’
More than 200,000 rhinoplasty patients are getting twice as many painkillers as they need from their plastic surgeons each year, a new study suggests
Rhinoplasty operations are the third most popular cosmetic surgery procedure, at a fairly accessible average cost of $5,000. Plastic surgeons performed an estimated 218,000 rhinoplasty operations in 2015.
In the study of 62 patients, the vast majority – 74 percent – used only 15 or less out of the 20 to 30 pain pills their surgeons prescribed.
‘For all surgeons in the practice opioid prescribing, it’s done on an arbitrary basis,’ says Dr Sagar Patel, lead study author. Prescription amounts are determined by ‘a combination of the practitioner’s experience and what other [doctors] are doing,’ he says.
If 74 percent of people who got nose jobs were prescribed 20 oxycodone tablets and used only 15, there were 800,000 unnecessary tablets floating around that year, from nose jobs alone.
‘The majority of pain pills being abused were originally legally prescribed, then diverted’ to other people, Dr Patel says.
Previous research has found that as much 71 percent of prescription opioid abusers got their drugs from a friend or family member who had leftover pain pills.
This study comes just after a Northwestern University study of emergency room patients suggested that Tylenol and Motrin may be just as effective as prescription opioids for reducing pain – at least in the short term.
A rhinoplasty operation often comes with swelling and bruising around the nose and eyes, but this usually begins to subside within a couple of days, and most patients are completely back to their normal daily routines within 10 days of surgery, according to the American Academy of Cosmetic Surgery.
As the study authors point out, the Centers for Disease Control and Prevention (CDC) published new guidance on general pain management in 2016 – most suitable for those with chronic pain – for healthcare providers, but does not provide the same directions treating pain after surgery.
‘The narcotic regimen a surgeon prescribes is generally based on the level of pain that the surgeon expects the patient to experience after a particular surgery,’ the study authors wrote.
‘This regimen varies by surgeon, and the decision may not be preceded by a specific discussion during the preoperative assessment about patient preferences and experiences with pain and pain medication.’
There is little to no consistency or formal regulation on how many pain pills patients are given after rhinoplasty operations, which raises questions about over-prescribing after other plastic surgeries.
There are only 35 states in the US – shown in orange in this map from the study that require doctors to access data on what opioids their patients have previously been prescribed, according to a new study
Between 67 and 96 percent of patients reported having leftover painkillers after surgery in a study published earlier this year in JAMA surgery.
‘We really are a service-based industry,’ Dr Patel says. ‘We want to please our patients, so you would think that we would be [more prone to] over-prescribe.’
But taken together with the previous study on general surgery, ‘it shows we really just don’t know’ how much pain medication patients need to recover from surgery, he says.
Oversight for surgeons and prescribers is also inconsistent from state to state. In 35 states, there are specific rules that require prescribers to pay attention to data from prescription drug monitoring programs (PDMPS). In these states, doctors can look at whether their patients have been previously prescribed pain medications.
The authors acknowledge that there is no perfect way to predict how much pain a patient will be in following surgery. But, ‘the initial step of our proposed process involves a thorough preoperative assessment and a discussion of pain specifically focused on the proposed operation,’ the authors write.
Their findings also suggest that 15 hydrocodone tablets may be a good baseline number, given that for almost three quarters of patients, this number was sufficient for managing pain.
‘We want practitioners to take our findings and, in their own practices, average it out so they know how much to be prescribing. We need to be creating a guideline for acute pain that will help prevent diversion,’ Dr Patel says.