Feb. 25, 2025 – Planning surgery? Talking to your doctor about pain management beforehand could keep you off the path to long-term opioid use, a risk factor for addiction. 

If the operation is of the spine, head, or neck, that goes double for you. People who have these procedures are among the most likely to get “new persistent opioid use,” or NPOU, according to a new study from Austria. Other surgeries with higher NPOU rates included knee replacement and removal of part or all of the colon.

“Pain relief after surgery is a key component to successful recovery after surgery,” said Mark Bicket, MD, PhD, an expert in pain management after surgery who was not involved in the study. “For patients worried about taking opioids, how to manage pain is an important topic to discuss with your surgeon before your procedure.” 

The findings, published this month in JAMA Network Open, align with previous research in the U.S. But this latest study is notable because Austrian doctors are considered less liberal in prescribing opioids than American ones are, and also because Austria has public health insurance. Among the efforts to curb the U.S. opioid epidemic is a focus on reducing opioid prescribing.

The researchers concluded that although health care system factors like prescribing restrictions likely play a role, a surgical patient’s history is important to consider as well. The study adds weight to an established link between prior opioid use and heightened risk of NPOU – meaning surgical patients who have previously taken opioids for any reason are at risk of taking them for months afterward, compared to those who are “opioid naïve,” a medical term for people who’ve never taken the highly addictive drugs. 

NPOU is not considered an addiction or misuse necessarily, but instead is defined as a “complication” of surgery. In the study, it was defined as filling at least one opioid prescription within the first 90 days after surgery, and then filling at least one more within the subsequent 90 to 180 days. The study included all types of opioid prescriptions, including for buprenorphine, dihydrocodeine, fentanyl, methadone and levomethadone, morphine, oxycodone, and tramadol.

The study included more than 550,000 people who had one of these surgery types sometime from 2016 through 2021: abdominal wall hernia repair, appendectomy, cholecystectomy, colectomy, mastectomy and other breast surgery, prostatectomy, thyroidectomy, laryngeal surgery and other head and neck procedures, hysterectomy, spine surgery, coronary artery bypass graft, and knee or hip replacement. Overall, 1.7% of people developed NPOU, with the highest rate observed among people who had spinal surgery, at 6.8%.

Studies in the U.S. have shown much higher rates of post-surgical NPOU (as high as 7%), the study authors noted. A study published in 2021 found that 1 in 5 people used opioids for longer than three months after total hip or knee replacement. 

The takeaway is not to tough out pain after surgery, though.

“It is important for patients to communicate with their physicians if their pain is not well managed after surgery,” said Bicket, a University of Michigan anesthesiologist and pain medicine specialist who cares for patients in the operating room, hospital, and outpatient clinic who have acute and chronic pain. 

“Poor pain management may signal a need to be examined by their surgical team. That check-in can help determine the right next step to keep their recovery on track,” he said. “One key risk from untreated or undertreated pain is chronic pain, so it’s important that pain is managed well after surgery.”