Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Optimal Opioid Prescription Length After Surgery

JAMA Surg; ePub 2017 Sep 27; Scully, et al

Opioid prescriptions after surgery should balance adequate pain management against the duration of treatment, with optimal length falling between the observed median prescription length and the early lowest requirement, a recent study found. 215,140 opioid-naïve individuals (aged 18 to 64 years) who had undergone 1 of 8 common surgical procedures between January 1, 2005, and September 30, 2014, and received and filled at least 1 prescription for opioid pain medication within 14 days of their index procedure were included. Researchers found:

  • 41,107 (∼19%) individuals received at least 1 refill prescription.
  • The median observed prescription lengths were 4 days for general surgery procedures, 4 days for women’s health procedures, and 6 days for musculoskeletal procedures.
  • The prescription lengths associated with lowest requirement for refill were 9 days for general surgery, 13 days for women’s health, and 15 days for musculoskeletal procedures.


Scully RE, Schoenfeld AJ, Jiang W, et al. Defining optimal length of opioid pain medication prescription after common surgical procedures. [Published online ahead of print September 27, 2017]. JAMA Surg. doi:10.1001/jamasurg.2017.3132.


The rate of prescriptions for opioid analgesics for the treatment of non-cancer pain has increased 4-fold since 1999. With that increase, there has also been a large increase in opioid abuse, as well as deaths from opioid overdoses. The concern is that overprescribing of opiate analgesics has contributed to the abuse epidemic.1,2 This study examined current prescription habits and the length of opioid prescription that leads to the lowest need for refills in order to formulate recommendations for the optimal prescription length for post-op opiates. From this data, it appears that about 1-2 weeks of opioids may provide adequate pain control while minimizing the need for refills and limiting the length of exposure to opioid analgesics. Within this range, it seems that a shorter length of prescription may be sufficient after general surgical procedures and a longer length needed after gynecologic and musculoskeletal procedures. —Neil Skolnik, MD

  1. Dart RC, Surratt HL, Cicero TJ, et al. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med. 2015;372(3):241-248. doi:10.1056/NEJMsa1406143.
  2. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016;315(15):1624-1645. doi:10.1001/jama.2016.1464.

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Postsurgical Opioid Prescribing & Potential Misuse, BMJ; ePub 2018 Jan 17; Brat, Agniel, et al

Pain & Fatigue Variability in Fibromyalgia Patients, J Pain; ePub 2017 Dec 15; Bartley, et al

Opioid vs Nonopioid Pain Reduction in the ED, JAMA; 2017 Nov 7; Chang, Bijur, et al

Positive Psychology Interventions for Pain Management, Clin J Pain; 2017 Nov; Peters, Smeets, et al

Steps to Address the Opioid Addiction Epidemic, JAMA; ePub 2017 Oct 24/31; Kolodny, et al