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Greater opioid intake did not improve patient satisfaction after ankle fracture treatment
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Disability, pain and satisfaction did not improve among patients with ankle fractures who were prescribed a greater amount of opioids at suture removal and follow-up, according to results.
“The wide variation in pain intensity for a given nociception is due largely to psychosocial factors that are highly responsive to cognitive behavioral therapy and related techniques,” David C. Ring, MD, PhD, told Healio.com/Orthopedics. “Efforts to bolster self-efficacy can do more to help people get comfortable than opioids.”
At the time of suture removal following open reduction and internal fixation of ankle fractures, Ring and colleagues recorded opioid use, trauma-related factors and scores on measures of disability, pain and treatment satisfaction in 102 patients. Overall, 59 patients completed the disability, pain and treatment satisfaction measures at 5 months to 8 months after suture removal, and researchers also recorded patients’ opioid use.
Results showed no association between opioid intake and disability or between opioid intake and treatment satisfaction or pain management satisfaction at the time of suture removal. Researchers also found no variables were associated with opioid intake at 5 months to 8 months after suture removal. At time of suture removal and at 5 months to 8 months after suture removal, the factors most consistently associated with disability, treatment satisfaction, satisfaction with pain management, pain at rest and pain with activity included psychologic measures of pain anxiety and catastrophic thinking.
Ring hopes these results will garner attention and help change the culture of prescribing opioids after orthopedic surgery.
“It makes people uncomfortable thinking about using so few opioids for pain relief,” Ring said. “We all need to understand this better. The next step is interventions to bolster self-efficacy. For many patients, that means delaying discretionary surgery.” – by Casey Tingle
Disclosures: Ring reports royalties from Skeletal Dynamics and Wright Medical Group and serves as a board member, owner, officer or committee member of the American Academy of Orthopaedic Surgeons and the Orthopaedic Trauma Association. Please see the full study for a list of all other authors’ relevant financial disclosures.
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