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Patients continue using opioids 6 months after TJA
Researchers noted change in joint pain was not predictive of opioid use at 6 months.
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Many patients who take opioids prior to total hip or knee arthroplasty will continue its use after surgery, and some opioid-naïve patients will become chronic opioid users, according to study results.
“Overall, we saw a trend toward opioid cessation, which is positive, but we saw more persistent use than we were expecting — especially among people who were taking opioids the day of their surgery,” Jenna Goesling, PhD, of the University of Michigan, told Orthopedics Today. “When people are already taking medication, you would expect them to continue taking it. However, when a patient getting a surgery to fix a pain problem, you would expect that would lead to reduction of medication use.”
Opioid use
Goesling and her colleagues assessed validated, self-reported measures of pain, function and mood among 574 patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) preoperatively and 6 months postoperatively.
Overall, 29% of all patients reported current opioid use the day of their surgery, according to results. Researchers found statistically significant higher levels of pain at the surgery site, stiffness, functional impairment, overall body pain and symptoms of depression, anxiety and catastrophizing among patients taking opioids the day of surgery compared to patients who were opioid naïve. Among patients taking opioids the day of surgery, 53.3% of patients who underwent TKA and 34.7% of patients who underwent THA reported opioid use 6 months after surgery. In comparison, 8.2% of TKA and 4.3% of THA patients who were opioid naïve the day of surgery reported persistent opioid use at 6 months.
According to univariate analyses of preoperative predictors of persistent opioid use, patients who were still using opioids at 6 months reported worse pain in their surgery site, greater functional impairment, more stiffness, increased overall body pain, more symptoms of depression and higher levels of catastrophizing.
Multivariate logistic regression showed overall body pain and opioid use at baseline were predictive of opioid use at 6 months, while change in joint pain was not predictive of opioid use at 6 months. Researchers found an association between decreased overall body pain and lower odds of being on opioids at 6 months.
“We were expecting to see a negative association with persistent opioid use and improvement in joint pain, and we just did not see that, which leads us to wonder what else people are using opioids for.” Goesling said. “Perhaps they have other pain in other parts of their body that they are continuing to take the medication for. Perhaps they are medicating emotional distress.”
Opioid intervention
While opioids are an important part of acute pain management, it is important for physicians to provide patients information on how they should safely use opioids following surgery, as well as information on other nonopioid coping strategies for pain management, such as cognitive behavioral strategies, Goesling said.
“Our long-term goal is to develop interventions that are both physician level interventions and patient level interventions,” Goesling said. “A physician level intervention would provide physicians with education about appropriate prescribing following a surgery, and patient level interventions would provide patients with information about what [they] should expect after surgery. Surgeries are going to hurt, and opioids are an excellent option to help with acute pain management, but opioids are typically not a long-term solution for chronic pain.” – by Casey Tingle
- Reference:
- Goesling J, et al. Pain. 2016;doi:10.1097/j.pain.0000000000000516.
- For more information:
- Jenna Goesling, PhD, can be reached at the University of Michigan, Back & Pain Center, Burlington Building 1, Suite 100, 325 E. Eisenhower Pwy., Ann Arbor, MI 48108; email: jennagoe@med.umich.edu.
Disclosure: Goesling reports no relevant financial disclosures.