Chronic opioid use increased rather than decreased after bariatric surgery, an observational study showed.

Among patients on the painkillers before surgery, 77 percent stayed on them over the next year as mean daily morphine equivalents rose 13 percent in the first year and 18 percent across three years after surgery (both P<0.001), Marsha A. Raebel, PharmD, of Kaiser Permanente Colorado in Denver, and colleagues found.

Magnitude of weight loss, depression, and chronic pain didn't appear to be significant factors, the researchers reported in the Oct. 2 issue of theJournal of the American Medical Association.

"These findings suggest the need for proactive management of chronic pain in these patients after surgery," they wrote.

While that had clear implications for follow-up care, it suggested how to prepare patients and referring physicians as well, commented Leslie Heinberg, PhD, behavioral services director for the Cleveland Clinic Bariatric and Metabolic Institute.

"Both physicians and patients come to surgery sometimes with the hope that the surgery and losing weight will help them significantly with their chronic pain, will allow them to experience less pain and thus less utilization of these types of medications," she told MedPage Today.

The study couldn't say whether patients felt less pain and wouldn't have caught longer-term changes, she noted.

But the lack of a decline in opioid dosing may not have been entirely unexpected, Daniel P. Alford, MD, MPH, an opioid dependence and chronic pain management expert at Boston Medical Center, noted in an accompanying editorial.

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