Treating postpartum pain? You may want to dial down the prescription

Physicians and other healthcare professionals who look after postpartum mothers may want to rethink the amount of medications they’re prescribing to treat pain after delivery, as well as how long they continue renewing these prescriptions. That’s one of the key takeaways from a study that set out to understand whether persistent opioid use after giving birth is linked to a move away from codeine prescriptions for postpartum patients to stronger options such as oxycodone. “You don't necessarily need to prescribe large amounts in the first prescription—you can prescribe smaller amounts or lower doses and then iteratively work with the patients to figure out how much they're going to need moving forward,” said study co-author Dr. Jonathan Zipursky, a clinician-scientist at Sunnybrook Health Sciences Centre. The study looked at a cohort of patients who filled a prescription for either codeine or oxycodone within seven days of discharge from hospital after delivery between Sept. 1, 2012 and June 30, 2020. The primary outcome was persistent opioid use—defined as one or more additional prescriptions for an opioid within 90 days of the first postpartum prescription and one or more additional prescriptions in the 91 to 365 days thereafter. The findings were surprising: Overall, having a prescription for opioids doesn’t necessarily lead to persistent use of the drug. The researchers did, however, find an association between a prescription for oxycodone and persistent use among patients who had a vaginal delivery. A similar association was not found among those who had a cesarian delivery. Read: Good for mom, good for baby: Treating post-partum depression with group CBT may help infants regulate emotions “We were surprised by a few things—our hypothesis was, originally, that oxycodone was going to be associated with a higher risk of persistent use,” said Dr. Zipursky. “There seem to be other factors that are more important than the type of opioids that are prescribed.” These factors appear to include the amount and duration of the prescription. The study found that a prescription containing more than 225 morphine milligram equivalents (MMEs)—about 30 tablets of 5-milligram oxycodone or 50 tablets of 30-milligram codeine—was associated with a roughly two-fold increased risk of persistent use among both patients who delivered vaginally or by C-section compared with less than 112.5 MMEs. “In addition, a prescription duration of more than seven days was also associated with a roughly two-fold increased risk of persistent use compared with a duration of one to three days after both vaginal and cesarean delivery,” wrote the study authors. The researchers also found that factors such as a history of mental illness, substance use disorder and a greater number of maternal comorbidities were strongly associated with persistent use. Dr. Zipursky said the study findings should not discourage healthcare providers from addressing the pain women often experience after childbirth. “People experience real pain in the postpartum setting, and it's really important to treat pain postpartum,” he said. “We know that if we adequately treat pain, it helps with breastfeeding, it'll help with maternal-infant bonding and also with mood. And the ability of moms to care for their babies—with treatment of their pain—is really important.” Read: Acetaminophen use during pregnancy associated with sleep problems in offspring

Treating postpartum pain? You may want to dial down the prescription

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