Study to examine why some surgery patients become long-term opioid users and others do not

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Jessica A. Fenske has spent a lifetime in and out of hospitals.

"I'm more of a fighter,” she said. “It’s been 30-some operations.”

She just had another hip surgery.

“It’s hard. You either live in pain or you take a pill and try to have a decent day. It’s a hard battle,” she said while lying in a hospital bed at the Mayo Clinic.

Despite relying on opioid painkillers for over a decade, she has never abused them.

Carl White broke his back, twice.

“I didn’t have a medicine cabinet at home, I had a medicine cupboard,” he said.

His exposure to opioids led to a full-blown addiction.

“So then it morphed from just treating the pain to being able to function,” White said.


Researchers at the Mayo Clinic are trying to figure out why some patients are able to take painkillers for a brief period and stop while others stay on them long-term and some fall into the quagmire of addictive behavior.

“What we hope to have is a nice model that may help us explain which patients are at risk,” said Dr. Michael Hooten of the Mayo Clinic.

Every year millions of Americans undergo surgeries. For many, it is the first time they are exposed to opioid medications. Staying on top of the pain from surgery is an important part of the recovery process.

Opioids can help with that.

“It just gives me enough relief of pain and a boost enough to do those things,” said Fenske.

However, long-term use of prescription painkillers can have serious consequences on the digestive system and the ability to think clearly.

Hooten has found the drugs can alter the way the brain senses pain and actually make the pain worse.

“What might be experienced prior to opioid use might be described as a minor type of pain; after exposure to the drugs and with longer term use, that sensation may be experienced as much more painful,” he said.

According to Hooten, about 25 percent of patients who take opioids will become long-term users


After shattering his back in two separate accidents, White was in a world of hurt.

“I basically needed to learn to walk again,” he said.  “At first I would take them as prescribed.”

For him, opioids not only took away physical pain but also made him feel better emotionally.

“Kept me from thinking about my past, kept me from having anxiety and worrying about my future,” he said.

White didn’t know it at the time, but he had risk factors which set him up for becoming an opioid addict. They included a family history of mental illness and alcoholism. Researchers have also found that people, who smoke, suffer from depression or anxiety disorder also run the risk of abusing an opioid prescription.

“My parents didn’t teach me good coping skills, if I was nervous, go have a drink,” White said.  “We need to find ways to deal with pain besides popping a pill.”

He is in recovery and no longer uses any medications for his chronic pain.

Instead, he relies on daily stretching and breathing techniques to take his mind off the hurt.


The challenge for doctors is to find a balanced approach to pain management. 

One that helps the patient recover without sending them down the path of long-term opioid use.

Fenske has used low dose painkillers for years, yet has the self-awareness to know that it is never okay to use the drugs just because she is having a bad day.

“If I take more than I'm supposed to, it starts making me agitated and irritable and I have signs where I don't feel good, so I know it’s not worth it, cut it off, stick where you’re at and it’s good,” she said.

“That’s the essence of this study, just what she said, what prevents her from going there versus the other people that you’ve talked with who didn’t recognize those red flashing lights and ran right through them,” said Hooten.

Over the next four years, Hooten, along with researchers at the University of Minnesota, Yale and Michigan will track the outcomes of hundreds of patients who have surgeries and are given opioid painkillers.

They hope to have a better understanding of how to tailor care that will minimize prolonged use of the drugs.

“Some individuals may receive very close surveillance or monitoring after they leave the hospital and that’s not necessarily done right now,” Hooten said.

One of the things they are working on is an app that will monitor a patient’s pain levels and medication use when they go home. It could offer up early warning signs that a person is developing a problem.

Another is to offer patients more intensive counseling before a surgery to explain what kind of pain they can expect, how long it will last and what alternative treatments are available.

The research project is being funded by a $5 million grant from the National Institutes of Health.