Erin Carey, MD, MSCR, assistant professor of obstetrics and gynecology and chief of the Division of Minimally Invasive Gynecologic Surgery, served as guest editor for a symposium in Clinical Obstetrics and Gynecology regarding opioid use in gynecology and chronic pelvic pain.
For the March 2019 issue, Carey solicited contributions that address the role of chronic opioid therapy in a gynecologic practice, including chronic pelvic pain, guidelines for opioid therapy and nonopioid solutions to pain, opioid tolerance and addiction and more. The symposium, “Opioid Use, Misuse and Abuse: The Rise and Fall of a National Opioid Epidemic,” is meant to provide evidence-based guidance for the prescribing and monitor of opioid therapy as recommended by Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain.
Carey authors the issue’s foreword, “Opioids Misuse and Abuse: The Making of a National Opioid Epidemic.” In her comment, Carey explains that the prescription opioid epidemic has among its main causes chronic pain, which affects more than 100 million Americans every year. Pain is a common complaint for OB-GYN patients and presents in a variety of clinical settings – the childbirth/postpartum period, before and after surgery, and in the ambulatory clinic – presenting the need for OB-GYNs to be skilled at identifying patients who require opioid medications and resourceful in using non-opiate drugs to treat pain.
Carey says perioperative opioid reduction is possible with the use of other opioid sparing analgesics, as well as enhanced recovery protocols, physician input and well-established patient expectations.
“Opioids are widely prescribed, however opioid knowledge and practice patterns vary among providers,” says Carey. “At UNC in benign gynecologic surgery Dr. AnnaMarie Connolly has led a program to reduce opioid prescriptions in the preoperative setting, a program which has been a painless practice for us to adopt, reducing our average number of opioids from 40 tabs to 20 tabs for major gynecologic surgery.”
Other UNC MIGS authors included in the symposium are Lauren Schiff, MD, assistant professor, Michelle Louie, MD, MSCR, assistant professor, and fellows Noor Abu-Alnadi, MD and Paul Tyan, MD. UNC MIGS alumni who contributed to the issue are Tarek Toubia, MD, MSCR; Arthur Dizon, MD, MSCR; Austin Findley, MD, MSCR; and Janelle K. Moulder, MD, MSCR.