Surgery backlog could lead to wave of new chronic pain and opioid dependencies

Opioid Addiction - image:
Opioid Addiction - image:

TORONTO – COVID-19 – The impact of the pandemic has implications for our future. There are economic impacts, mental health impacts, and health ramifications.

As Canada’s vaccination rates climb and hospitals begin to tackle the mountain of postponed surgeries due to the pandemic, we are facing an echo epidemic of new chronic pain sufferers. Studies show that roughly 30 per cent of those undergoing surgery will go on to develop chronic pain, and about 25 per cent of all chronic pain conditions originate from surgical procedures.1,2 This has a detrimental effect on families, communities and the healthcare system. However, with recent innovations in genetic testing this does not have to be the fate for the thousands of Canadians who are about to have surgery.

The risk of chronic pain following surgery is high. As patients experience pain associated with postoperative recovery, inadequate pain relief can lead to autonomic and endocrinological changes that cause pain to become chronic.3 This process can happen in a matter of weeks, so optimizing pain relief right from the start is critical. The risk may be further compounded by the current “echo pandemic” of mental health issues, as depression and anxiety significantly increase the risk of developing chronic pain after surgery.

Advancements in genetic testing, termed pharmacogenetics (PGx), gives insight into which pain drugs will be most compatible with a person’s DNA. This allows for more effective treatment, accurate dosing and mitigation of the risk of developing the syndrome that leads to chronic pain and the risk of building drug tolerance or dependencies to opioids. When completed ahead of surgeries, patients and physicians can use this information to inform anesthesia and postoperative care, enabling better pain control and improving safety by reducing the risk of adverse drug events.

“PGx testing can be a useful tool in ensuring the hundreds of thousands of patients about to have surgery will have their postoperative pain safely and effectively managed, helping limit their risk for developing chronic pain and minimizing their exposure to opioids,” said Dr. Lydia Hatcher, Associate Clinical Professor of Family Medicine at McMaster University, with a focused practice in chronic pain. “While not yet a standard practice, completing a PGx test can support healthcare practitioners in taking a more personalized approach to postoperative care and ultimately better inform a patient’s recovery.”

One in four Canadians currently live with chronic pain, which is associated with the worst quality of life compared to other chronic diseases.4 It significantly impacts individual physical and mental health, family and community life, and the economy, with a total direct and indirect cost of $38.3 to $40.4 billion in 2019.5 Moreover, the COVID-19 pandemic has greatly impacted those already suffering from chronic pain — recent reports show that 2 out of 3 Canadians with chronic pain have seen their condition worsen with the pandemic.6 Disruption to care has also led to an increase in use of pharmaceutical interventions to manage pain, with 53 per cent of Canadian adult multidisciplinary pain clinics reporting an increase in medication use by patients.7

“We have an opportunity to get in front of a major challenge by using a simple genetic test to better inform the prescribing process, and before surgery patients risk developing additional concerns or conditions,” said Nancy White, CEO of Inagene Diagnostics Inc., a Toronto-based provider of pharmacogenetic testing. “If you have the chance to optimize your pain management, and reduce side effects and safety risks, why wouldn’t you do it?”

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