Adolescents after major surgery: severe pain resolved within days, yet 40% were still using opioids in weeks three and four

Design

Prospective cohort with text-message surveys over 5 months

Population

340 adolescents with outcome data at month 3, including 141 after major procedures (median age 15)

Primary outcome

Persistent surgical-site pain at month 3

Effect

Persistent pain 57.9%; opioid use in weeks 3 and 4 in 39.6%; severe pain resolved in a median of 3 days

This prospective cohort followed adolescents through text-message surveys for months after surgery. Three hundred and forty provided outcome data at month 3, of whom 141 had major procedures (median age 15).

In the major-procedure group, severe pain (7 to 10 out of 10) resolved within a median of 3 days. Even so, persistent surgical-site pain was reported by 57.9% (81 patients) at month 3, and 39.6% (44 patients) used opioids in weeks 3 and 4, after the period when severe pain had settled. Only 9.2% were unhappy or very unhappy with their recovery. The odds of persistent pain fell by 25% a month (OR 0.75, 95% CI 0.67 to 0.83). Female sex was the only significant individual predictor (OR 1.95, 95% CI 1.11 to 3.42).

The cohort was observational and the pain was self-reported, so it describes what happens rather than what to change. It does suggest that opioid stopping plans for teenagers should not depend on a prescriber remembering to ask.

• Give adolescents an explicit plan for stopping opioids once severe pain has settled.
• Ask about pain and opioid use again at weeks two to four, not only at discharge.
• Counsel that mild ongoing pain at three months was common and usually improved over time.
• Consider that girls had higher odds of persistent pain in this cohort.

Why it matters

Teenagers' opioid use outlasted their severe pain, and that is the window in which dependence can start.

Don't overread it

Observational and descriptive, with only 141 major-procedure patients; it does not show that any intervention reduces prolonged use.

The statistics, in plain English

An odds ratio of 0.75 per month means that, on average, the odds of still having pain fell by a quarter each month. Persistent pain at three months was measured by patient report and is not the same as disabling pain.

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