Opioid (Levy 2015). According to Clarke et al approximately

Opioid prescriptions following major and minor surgeries have substantially increased in the last few decades (Wright 2014, Larochelle M 2015, Hill 2017, Walijee 216, Wunsch 2016, Voepel-Lewis 2015). Surgeons are considered one of the higher prescriber of opioids among various specialties (Levy 2015). According to Clarke et al approximately 50% surgical patients are discharged on opioid prescription in Ontario Clarke 2014; out of which 3-10% of the patients continue to take prescribed opioids beyond 90 days after the surgery (Clarke 2010, Clarke 2014). Increased opioid use after the surgery is associated with increased socioeconomic burden, morbidity (Solomon 2010, Leider 2011, and Kehlet 2003), and mortality (Bohnert 2011, Clarke 2014, and Kern 2015). Patients who consumed opioids for longer duration may require escalating opioid doses Ballantyne J 2007 and are at risk of opioid abuse or misuse (McCabe 2013, Vaughn 2016). Patients taking opioids for longer duration are also prone to develop tolerance and hyperalgesia, Dupen 2007 and other dangerous and potentially costly opioid-related side effects Benyamin 2008. There is also a lack of information about the safety and efficacy of long term use Kalso 2004, Martell B 2007.

Common expectation is that pain after the surgery will resolve in few weeks (Kalso 2003). Current guidelines recommend detailed screening and assessment of a patient prior to prescribing opioids to patients Eriksen 2003, Gilson 2004; Chou R 2009. Studies have shown that patient with co morbidities, and psychological conditions are more likely to use opioid after 90 days of the surgery (Clarke 2014, Schramm-Sapyta 2009). Previous studies had limitations as those studies focused on the harmful behavior in chronic pain patients Adams 2006, Banta-Green C 2009, HĂžjsted J 2007, Noble 2008, in war veterans (Edlund M 2010, Macey 2011, Wu 2010). These studies also suffered with limitation as they included patients who were already taking opioids. Studies also explored the prevalence opioid use work related acute back injuries Stover 2006 but those studies suffered with limitation as those studies enrolled patients who already took opioid medications. Thus understanding about the risk factors associated with prolonged opioid use remains unclear. Recent studies have explored risk factors associated with prolonged opioid use after surgery for non-cancer painful conditions (Soneji 2016, Alam 2012, Sun 2016, Clarke 2014, and Brummetti 2017). These studies have used variable definition for prolong opioid use or explored risk of opioid use specific surgical conditions such as knee arthritis. Studies have also shown that patients prescribed opioid within seven days of low risk surgery are more likely to continue use opioid after 90 days post operatively Alam 2012. There is also lack of consistency regarding the risk factors among various studies (Edlund 2007, Edlund 2010, and Seghal 2012).

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