The use of Opioids for Stones and Ureteral Stents: Insights from an EDGE Consortium Patient Survey
Annah J. Vollstedt, MD1; Manoj Monga, MD2; Anna Zampini, MD2; Amy Krambeck, MD3; Ojahs Shah, MD4; Roger Sur, MD5; Ben Chew, MD6; Brian Eisner, MD7; Stephanie Thompson, MD4; Tammer Yamany, MD7; Vernon Pais, MD1
1Dartmouth Hitchcock Medical Center, Lebanon, NH; 2Cleveland Clinic, Cleveland, OH; 3Indiana University, Indianapolis, IN; 4Columbia Univerisity, New York, NY; 5University of California, San Diego, San Diego, CA; 6University of British Columbia, Vancouver, BC; 7Massachusetts General Hospital, Boston, MA
BACKGROUND: With the spotlight on the nation's opioid crisis, urologists should analyze the use of opioid analgesics. Kidney stones are recognized as inherently painful. Furthermore, ureteral stents are recognized as a source of significant postoperative discomfort for many patients undergoing endourologic interventions for stone. Given high recurrence rate of urolithiasis, the implications of opioid use are potentially multiplied in this population. Using a patient survey, we sought to investigate the use of opioids both during acute episodes of urolithiasis and after urologic surgery in which a stent was placed post-operatively.
METHODS: A previously validated survey assessing impact of decreased quality of life and use of opioid pain medication was distributed to patients with a history of ureteral stent at seven academic centers between July 2016 and September 2017. Responses were encoded in duplicate to ensure accuracy. Statistical analysis was performed using Chi square analyses, Stata 13.1.
RESULTS: A total of 249 surveys were completed, 116 (47%) were from female patients. Most patients (75%, 186/249) used an opioid at some point during either their acute stone episode or for stent-related pain. 61% (147/242) of patients reported using opioid pain medication for their stone pain, versus 39% (94/242) who used opioids for stent-related pain. Patients with increased number of prior stone episodes were more likely to use opioids for their most recent episode (p <0.001). In addition, increasing age was associated with a decrease in likelihood of needing opioids for stone pain (p =0.014). Younger patients were more likely to use opioids for stent-related pain (p<0.001). This held true when accounting for sex, patient-perceived health status, and the number of prior stone episodes. When assessing whether patients used more opioids for their stent-related pain or the stone pain, 46.5% reported using more opioids for their stone episode than for stent-related pain, while 16% reported using more opioids for the stent-related pain. Only 10% (25/249) patients required opioids only for the stent-related pain and not the stone pain.
CONCLUSIONS: Amid a national opioid epidemic, it is important to assess patient perspectives on opioid utilization. Patients who have suffered through more prior episodes are more likely to have used opioids for their most recent episode. Although ureteral stents have been shown to be associated with a decreased quality of life, our study shows that the use of opioids for stent-related pain is less than that for stone pain. Younger patients are less likely to tolerate a stent without opioid analgesics. Such findings may help target those for whom more aggressive opioid-alternative strategies should be developed.
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