Text Message Monitoring of Pain, Opioid Use After Surgery Suggests Patients Over Prescribed

A woman using her smartphone.
A woman using her smartphone.
The researchers’ objective was to determine the difference between the number of opioid tablets prescribed and those taken after orthopedic and urologic surgeries via a text messaging system.

Text message monitoring of pain and opioid usage following surgery may allow clinicians to better tailor prescriptions and avoid excess opioid distribution. These findings from a quality improvement study were published in JAMA Network Open.

Patients undergoing orthopedic (n=742) or urologic (n=177) surgeries in 2019 at the Hospital of the University of Pennsylvania or Penn Presbyterian Medical Center were invited to participate in this study.

Patients were asked via text messaging to report pain intensity and tolerability on a 0-to-10-point scale, with 10 being the most pain and the most tolerable pain, respectively, and asked about their opioid use and plans to consume their opioid medication in coming days. Messages were sent on days 7, 14, 21, and 28 after surgery and ceased when patients reported they had stopped using their pain medication.

Patients who underwent orthopedic or urologic procedures had a median age of 48 years (interquartile range [IQR], 32-61) and 56 (IQR, 40-67), 51.8% and 15.2% were women, and 66.7% and 80.7% were White, respectively. Compared with patients who declined to participate in the study (n=1118), patients undergoing orthopedic surgery who participated were younger (P <.001), less ethnically diverse (P <.001), and more were opioid naïve (P =.003).

Among orthopedic surgeries, average pain at day 4 was reported as 4.72 (standard deviation [SD], 2.54). Pain intensity varied by surgical procedure, ranging from upper extremity repair (mean, 3.60; SD, 2.71) to nondistal radius upper extremity fracture (mean, 6.38; SD, 2.33).

Overall pain intensity decreased by 0.89 (SD, 1.64) on day 7, 1.32 (SD, 2.04) on day 14, and by 0.40 (SD, 1.91) on day 21. Ability to manage pain was an overall mean of 7.32 (SD, 2.59) at day 4.

Among urologic procedures, overall pain intensity was 3.48 (SD, 2.43) and ability to manage pain was 7.34 (SD, 2.81) at day 4. Pain intensity was reported to decrease by 1.20 (SD, 2.38) at day 7, by 1.18 (SD, 1.47) on day 14, and 1.50 (SD, 2.12) on day 21.

Patients undergoing orthopedic and urologic procedures were prescribed a median of 20 (IQR, 15-30) and 7 (IQR, 5-10) opioid tablets and 21.1% and 11.1% received a refill within 30 days, respectively. Following orthopedic procedures, patients consumed a median of 6 (IQR, 0-14) tablets, with the greatest consumption occurring among patients who underwent a hip arthroplasty (median, 15; IQR, 5-21). For urologic procedures, patients consumed a median of 1 (IQR, 0-4) tablet.

By day 7, among all patients, the median number of opioid tablets consumed was 0 (IQR, 0-2). In total, 15,581 tablets were prescribed and 9452 were unused. Most patients (64.1%) consumed less than half of their tablets, and 27.8% did not use any of their prescribed opioids.

This study may have been biased by its high nonresponse rate and significantly different characteristics between responders and nonresponders among the orthopedic surgery cohort.

These data indicated patients were prescribed far more opioid tablets than they required after orthopedic or urologic surgical procedures. Text message monitoring may allow for additional information that better inform clinical decisions about opioid distribution.


Agarwal AK, Lee D, Ali Z, et al. Patient-reported opioid consumption and pain intensity after common orthopedic and urologic surgical procedures with use of an automated text messaging system. JAMA Netw Open. 2021;4(3):e213243. doi:10.1001/jamanetworkopen.2021.3243

This article originally appeared on Clinical Pain Advisor