In Reply

Letters to the Editor regarding the article The Incidence and Risk Factors of Persistent Opioid Use After Surgery A Retrospective Secondary Data Analysis by Johannes Dreiling, Norman Rose, Christin Arnold, Philipp Baumbach, Carolin Fleischmann-Struzek, Christine Kubulus, Marcus Komann, Ursula Marschall, Heike Lydia Rittner, Thomas Volk, Winfried Meißner, and Daniel Schwarzkopf in issue 23/2024

We thank Wörz for his contribution, which once again confirms the differences in how opioids are handled between the US, Canada, and several other countries on the one hand and Germany on the other hand. We also agree with the statement that persistent opioid use after surgery may be indicated for pain treatment in some cases. We mentioned the limitations of the secondary data analysis regarding the lacking documentation of the indication in drug prescriptions (1). The incidence of persistent opioid use after amputations is likely to be associated with the high prevalence of phantom pain (ca 70%) and on the other hand with its duration and severe impairment for patients. On this background, opioid administration for six months after surgery may well be indicated—even though opioids are not first-line therapy for phantom pain/neuropathic pain. Not least because long-term opioid treatment is often associated with constipation and development of tolerance and does not represent a curative approach.

We hope that our article (1) continues to draw attention to potentially no longer indicated opioid therapies and their consequences and strengthens approaches that entail systematic follow-up care (3) and monitoring after procedures with a high risk for persistent opioid use after surgery, such as amputations, spinal and orthopedic surgery.

DOI: 10.3238/arztebl.m2025.0037

On behalf of the authors

Dr. med. Johannes Dreiling

Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena

Conflict of interest statement

The authors of both contributions declare that no conflict of interest exists.

References

1. Dreiling J, Rose N, Arnold C, et al.: The incidence and risk factors of persistent opioid use after surgery—a retrospective secondary data analysis. Dtsch Arztebl Int 2024; 121: 757–63

2. Limakatso, K, Ndhlovu, F, Usenbo, A, et al.: The prevalence and risk factors for phantom limb pain: A cross-sectional survey. BMC Neurol 2024; 24: 57

3. Mikhaeil J, Ayoo K, Clarke H, Wąsowicz M, Huang A: Review of the transitional pain service as a method of postoperative opioid weaning and a service aimed at minimizing the risk of chronic post-surgical pain. Anaesthesiol Intensive Ther 2020; 52: 148–53