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Editor's Correspondence |

Long-term Analgesic Use: Sometimes Less Is Not More

Vijay Krishnamoorthy, MD; Paul Bhalla, MBChB, FRCA
Arch Intern Med. 2012;172(15):1189-1190. doi:10.1001/archinternmed.2012.2085.
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We read with interest the article by Alam et al.1 The investigators reported that the risk of long-term opioid use is greatly increased when prescribed in the first 7 days following a low-pain short-stay surgical procedure and suggest that “long-term postoperative analgesic use may best be addressed by preventing its initiation.”1(p428)

We wonder if these conclusions can be wholly justified based on the figures presented and whether the problem of chronic postsurgical pain may be more significant than the authors suggest. It has been shown that the incidence of moderate to severe pain 24 hours after cataract surgery may be as high as 6.8%, and after laparoscopic cholecystectomy, 57.1%.2 This is certainly not low-pain surgery. The authors' figures show that most patients undergoing cataract surgery do not need further analgesia, but there is a group of patients who need pain relief in the subsequent week. It has been shown that pain at 24 hours may be much worse than immediately after the procedure.3 Rather than overprescribing analgesia in the first week, are we underestimating the pain of cataract surgery and putting patients at risk of chronic postsurgical pain at 1 year?

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August 13, 2012
Asim Alam, MD; Tara Gomes, MHSc; Chaim M. Bell, MD, PhD
Arch Intern Med. 2012;172(15):1189-1190. doi:10.1001/archinternmed.2012.2897.
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