Some wise counsel in advance can reduce the amount of opioid painkillers a patient takes after orthopedic surgery, new clinic trial results show.

Knee surgery patients were much less likely to take oxycodone if they were counseled to pop the pills as a “last resort” if pain becomes unbearable, researchers report in the Journal of Bone and Joint Surgery.

“Over a third of patients in the ‘last resort’ group took no opioids at all after surgery,” senior researcher Dr. R. Frank Henn III, chair of orthopedics at the University of Maryland School of Medicine, said in a news release. “In contrast, 9 of 10 patients in the standard-of-care group used opioids after surgery.”

Despite using fewer opioids, the “last resort” patients had about the same average pain scores as those taking painkillers as usual, the study says.

Under standard pain management, doctors counsel patients to take painkillers as needed for severe pain and to “stay ahead of the pain,” researchers said in background notes.

But overprescribing of painkillers contributed to an opioid crisis during the past two decades, with more than 800,000 people dying from opioid overdoses between 1999 and 2023, according to the U.S. Centers for Disease Control and Prevention.

As a result, doctors have been looking at ways to reduce opioid use after surgery, researchers said.

For this study, researchers recruited 121 patients undergoing anterior cruciate ligament (ACL) reconstruction, a common orthopedic surgery for which opioid painkillers are often prescribed, researchers said. The surgeries took place at the University of Maryland Rehabilitation & Orthopedic Institute.

Half of the patients were counseled to use opioids as a “last resort” for pain, while the other half received the standard advice, researchers said.

After three months, patients in the “last resort” group had taken substantially less oxycodone on average than the standard treatment group, 15 mg versus 53 mg, results show.

Of “last resort” patients, 1 in 3 needed no opioid painkillers at all, researchers found.

Despite that, pain intensity scores were about the same, 2.5 out of 10 in the “last resort” group and 2.4 in the standard treatment group, the study says.

“We found that patients who were told to take opioids only as a last resort took significantly less opioids and had fewer refills, with no observed differences in pain scores, sleep quality or satisfaction,” Henn said.

The “last resort” patients also suffered fewer side effects from opioid drugs, including nausea, constipation, GI upset and drowsiness, the study says.

“This study provides convincing evidence that we should abandon the practice of counseling patients to take opioids to ‘stay ahead of the pain’ and counsel them to take them as a ‘last resort’ to manage pain,” lead researcher Dr. Jonathan Packer said in a news release.

“Taking additional opioids following surgery does not improve postoperative pain and has no benefit to patients,” said Packer, an orthopedic surgeon and sports medicine specialist at the University of Maryland Medical Center, who added, “We believe that this approach is applicable to all surgeries, and we strongly recommend that clinicians consider adopting this simple strategy in their practice.”

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