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Study: Many patients who already take opioids continue their use after joint replacement
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According to results recently published in Pain, many patients who took opioids prior to total knee or total hip arthroplasty persisted to use opioids 6 months postoperatively and a smaller percentage of patients who were opioid-naïve preoperatively also remained on opioids at the follow-up.
“After a successful surgery as pain in the affected joint improves, we would expect that opioid use would no longer be needed,” Jenna Goesling, PhD, told Orthopedics Today. “Counter to our hypothesis, we did not find an association between changes in joint pain and persistent opioid use. It was also surprising that such a large percentage of patients who were taking opioids the day of surgery continued to take opioids at 6 months. Taken together, the findings suggest that patients may be taking opioids for reasons other than pain in the joint.”
Jenna Goesling
Goesling and colleagues administered a validated, self-reported questionnaire preoperatively to 574 patients who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA) and followed patients to assess surgical outcomes. Investigators collected postoperative data via telephone at 1 month and 3 months, and by mail at 6 months. Opioid use was also recorded. Patients were also assessed with the WOMAC, the Brief Pain Inventory, Hospital Anxiety and Depression Scale, and the Coping Strategies Questionnaire.
Investigators noted 53.3% of TKA patients and 34.7% THA patients who reported opioid use on the day of the procedure also used opioids at 6 months postoperatively. Patients who took greater than 60 mg of oral morphine equivalents preoperatively had an 80% greater chance of persistently using opioids after surgery, according to the study.
Among patients who were opioid-naïve prior to the procedure, 8.2% of patients who underwent TKA and 4.3% of patients who underwent THA used opioids at 6 months postoperatively. According to researchers, factors at the day of surgery for continued opioid use among previously opioid-naïve patients included a greater overall body pain, greater affected joint pain and greater catastrophizing. Decreases in overall body pain from baseline to 6 months postoperatively among patients who used opioids on the day of surgery and those who were opioid-naïve correlated with lower odds of opioid use at 6 months. Investigators noted a change in affected joint pain was not a predictor of opioid use.
“Improving patients’ expectations about post-surgical pain and increasing their knowledge about how to use opioids after surgery is an important next step in reducing opioid use following surgical interventions,” Goesling said. ‒ by Monica Jaramillo
Reference:
Goesling J, et al. Pain. 2016;doi:10.1097/j.pain.0000000000000516.
Disclosures: Goesling reports the study was funded by the R01AR060392 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Perspective
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Robert T. Trousdale, MD
The article entitled “Trends and predictors of opioid use after total hip and total knee arthroplasty” by Goesling and colleagues provides important data that highlight a lot of issues that are critical for our total joint patients in 2016. In summary, this articles states patients who require a total knee replacement are at higher risk for continued opioid use than our total hip population. Secondly, those patients who are taking the opioids prior to the surgery are at a substantially higher risk of using opioids at 6 months after the procedure. Maybe most impressively, just under 10% of our total knee patients and 5% of our total hip patients who have never required opioids prior to surgery are still taking opioids at 6 months. Furthermore, the researchers document risk factors (in a validated self-reported tool) for long-term opioid use.
I think this article highlights the need for orthopedic surgeons to engage with their pain medicine colleagues in the treatment of perioperative and postoperative pain. Certainly, using opioids in more than half of our total knee patients and a third of our total hip patients at 6 months after surgery is not acceptable.
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