Prof. Luft mentions the problems triggered by frequent prescription of opiates/opioids in the USA. He emphasizes rightly that this is (in part) caused by doctors‘ prescribing habits and the marketing efforts of the pharmaceutical industry (1). With regard to our article he addresses two different problems: an increasingly common discussion topic relates to whether acute therapy with opioids, which is only intended for the acute postoperative phase, may evolve into long-term therapy, which was not originally intended (2)—especially as patients are discharged ever more quickly. Prof. Luft is right in that doctors are responsible for this—whether that is a result of not finishing acute treatment in hospital or non-indicated continuation of treatment after discharge.
We do not hold the view that the deficiencies in postoperative pain therapy that we discussed in our article should be remedied by prescribing more opiates. Even today, underprovision of opiates/opioids is probably rife in some hospitals and, in particular, in certain groups of patients. Another evaluation of QUIPS data showed that after cesarean sections, 62% of patients were not given any postoperative opioids at all in spite of severe pain, in settings where these were administered by medical staff (3). In our current analysis, however, we suspect that the possible deficiencies in hospitals providing higher levels of care were not caused by too few opioids but—at least in part—by poor communication, frequent staff changes, and a lower attention threshold vis-à-vis pain problems (4).
On behalf of the authors
Prof. Dr. med. Winfried Meißner
Klinik für Anästhesiologie und Intensivmedizin, Jena,
Conflict of interest statement
Prof. Meißner has received consultancy payments from AcelRX, BioQ Pharma, Grünenthal, Medicines Company, and Menarini, as well as lecture honoraria from BioQ Pharma, Grünenthal, Menarini, and Mundipharma. He has received third-party funding from Pfizer and financial support for clinical studies from Grünenthal.
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|2.||Brummett CM, Waljee JF, Goesling J, et al.: New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg 2017: e170504 CrossRef MEDLINE|
|3.||Marcus H, Gerbershagen HJ, Peelen LM, et al.: Quality of pain treatment after caesarean section: results of a multicentre cohort study. Eur J Pain 2015; 19: 929–39 CrossRef MEDLINE|
|4.||Meißner W, Komann M, Erlenwein J, Stamer U, Scherag A: The quality of postoperative pain therapy in German hospitals—the effect of structural and procedural variables. Dtsch Arztebl Int 2017; 114: 161–7 VOLLTEXT|