Shared decision-making tool may reduce opioid use after hand surgery
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Use of a shared decision-making tool during hand surgery may yield equivalent or better pain control and reduce the number of opioids prescribed, according to published results.
“Shared decision-making tools have an important role in educating patients about their orthopedic perioperative care,” Rajshri M. Bolson, MD, FAAOS, assistant chief of surgery at VA Eastern Colorado Health Care, told Healio. “Our study showed that a simple but effective educational tool used as part of the shared decision-making model could reduce opioid prescribing without compromising pain control after surgery.”
Bolson and colleagues randomly assigned 53 patients undergoing outpatient carpal tunnel release, trigger finger release or ganglion cyst excision to either use an educational, shared decision-making tool that presented information on postoperative pain, opioids and alternative modalities of treatment (shared tool group; n=25) or to receive a survey only (no tool group; n=28). Researchers surveyed patients for 4 weeks after surgery, which included patient-reported outcome measurement information system pain intensity and pain interference scores, as well as the number of oxycodone or over-the-counter pills taken.
Results showed patients in the shared tool group received an average of 6.4 oxycodone pills vs. an average of 10 oxycodone pills for patients in the no tool group. Researchers found patients in the shared tool group and no tool group took a median of 2 and 3 oxycodone pills in the first week after surgery, respectively. Although patient-reported outcome measures for pain intensity and pain interference were not significantly different for postoperative weeks 1, 3 and 4, researchers noted patients in the shared tool group had a significantly lower pain interference score for postoperative week 2.
“We need to continue to understand what tools are most effective and how to best implement them in practice,” Bolson said. “By taking the time to build these types of tools and make shared decision-making a routine part of our practice, we, as orthopedic surgeons, can make a big impact in optimizing the care of our patients.”
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This research performed by Rajshri Bolson, MD, and colleagues is yet another example of the importance of patient engagement in postoperative pain control. The authors demonstrated how the use of patient education in a shared decision-making tool in veterans (who are at higher risk for opioid-use disorder) could improve pain management with fewer opioid pills prescribed.
In hand surgery, especially with minor procedures such as carpal tunnel and trigger finger release, evidence demonstrates that patients have similar pain intensity and satisfaction despite whether opioids are prescribed. To attain this result, however, patient education through setting expectations and providing education on alternative pain management strategy is essential.
Most orthopedic surgeons are aware of the opioid crisis and have adjusted their opioid prescribing strategies; however, we can do better than simply providing less postoperative opioids. To continue our progress in providing excellent postoperative pain management after orthopedic surgery while reducing opioid use, patient pain management education should be standardized and as automatic and routine as prescribing pain medication after surgery.
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