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What is the role of opioids in postoperative pain? Epidemiological and clinical perspectives


Project Description

The question seems trivial but remains largely unresolved. The present project aims to address the question using different approaches: retrospective, prospective, observational and potentially interventional.

First, if the importance of the opioid-related problems is well recognised, its magnitude is not known in the country (1-3) and the association with serious adverse events has not been well described.
In the USA, the opioid-crisis led to professional organisations recommending the implementation of specific strategies (4). This may be easily set up in Scotland, by using specific pathways to prevent and/or manage the problem, but a clear description of this is of prime importance before allocating resources.

Looking at publications about persistent postoperative opioid use in Europe gives a wide range of results. Opioids have been prescribed, for at least three months after surgery/discharge, to 7.9% to 41% of the patients. Especially hip fracture surgeries and total hip arthroplasties show high user rates (33% - 41%). The limitation of this comparison is the very small number of studies that assessed a long-term opioid use and a low to very low quality of data.

In summary, the numbers of opioid users three months after surgery are higher than expected, but due to the lack of quality in the data, it is not possible to give a general statement about the prescribing rates in Europe. Prospective research is thus needed.

Such a prospective study will have as objective to assess the magnitude of persistent opioid use in Europe. We will also describe its association with adverse events and persistent pain.
The primary outcome will be the amount of any opioid, used during the preoperative month (preoperative use), during surgery, after three months, and up to the end of the postoperative year. This last outcome may be restricted to a subsample depending on the availability of prescription data.
The secondary outcomes will be the incidence of preoperative pain, and at the end of the third postoperative month (persistent pain with/without the presence of neuropathic components). The potential association between opioid use and pain outcomes will be investigated.

This may lead to interventional studies focusing on different aspects, all aiming to directly address patient-centred problems:
→ In the preoperative period, by optimizing the patient before, especially the opioid-user.
→ In the intraoperative period (e.g. opioid-sparing strategies).
→ In the postoperative period (acute pain services and transitional pain units).

APPLICATION PROCEDURE:
This project is advertised in relation to the research areas of APPLIED HEALTH SCIENCE. Formal applications can be completed online: https://www.abdn.ac.uk/pgap/login.php. You should apply for Degree of Doctor of Philosophy in Applied Health Science, to ensure that your application is passed to the correct person for processing.

NOTE CLEARLY THE NAME OF THE SUPERVISOR AND EXACT PROJECT TITLE ON THE APPLICATION FORM.

Candidates should contact the lead supervisor to discuss the project in advance of submitting an application, as supervisors will be expected to provide a letter of support for suitable applicants. Candidates will be informed after the application deadline if they have been shortlisted for interview.

Funding Notes

This project is part of a competition funded by the Institute of Applied Health Sciences. Full funding is available to UK/EU candidates only. Overseas candidates can apply for this studentship but will have to find additional funding to cover the difference between overseas and home fees (approximately £16,625 per annum).

Candidates should have (or expect to achieve) a minimum of a First Class Honours degree in a relevant subject. Applicants with a minimum of a 2:1 Honours degree may be considered provided they have a Distinction at Masters level.

References

(1) Glare P, Aubrey KR, Myles PS. Transition from acute to chronic pain after surgery. Lancet. 2019 Apr 13;393(10180):1537-1546.

(2) Neuman MD, Bateman BT, Wunsch H. Inappropriate opioid prescription after surgery. Lancet. 2019 Apr 13;393(10180):1547-1557

(3) Colvin LA, Bull F, Hales TG. Perioperative opioid analgesia-when is enough too much? A review of opioid-induced tolerance and hyperalgesia. Lancet. 2019 Apr 13;393(10180):1558-1568.

(4) Kent ML, Hurley RW, Oderda GM, Gordon DB, Sun E, Mythen M, Miller TE, Shaw AD, Gan TJ, Thacker JKM, McEvoy MD; POQI-4 Working Group. American Society for Enhanced Recovery and Perioperative Quality Initiative-4 Joint Consensus Statement on Persistent Postoperative Opioid Use: Definition, Incidence, Risk Factors, and Health Care System Initiatives. Anesth Analg. 2019 Aug;129(2):543-552.

(5) Ramsay G, Haynes AB, Lipsitz SR, Solsky I, Leitch J, Gawande AA, Kumar M. Reducing surgical mortality in Scotland by use of the WHO Surgical Safety Checklist. Br J Surg. 2019 Jul;106(8):1005-1011.

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