Pre-surgical patients with osteoarthritis commonly use opioids to manage pain

SAN DIEGO — Thirty percent of patients with end-stage knee, hip or spine osteoarthritis used opioids to manage chronic pain before surgery, according to data presented at the American College of Rheumatology Annual Meeting.

“Growing evidence demonstrates little if any clinically significant benefit of opioids for OA pain, particularly when compared to other medications,” lead study author Y. Raja Rampersaud, MD, FRCS(C), a professor in the division of orthopedic and neurosurgery at the University of Toronto, said in a press release. “There are growing concerns about the potential for misuse, dependency and increased adverse events, including opioid-related death. Limited published research in this area suggests that preoperative opioid use may be associated with poorer clinical and patient-reported outcomes.”

Rampersaud and colleagues studied data from questionnaires of patients with knee (n = 577), hip (n = 459) or spine (n = 168) OA (mean age, 65.6 years; 55.5% were women) who were scheduled for surgery. Participants reported on the frequency of their opioid use (never, sometimes or daily) and use of NSAIDs, antidepressants or neuroleptics and over-the-counter medications. Participants also answered questions on their sociodemographic characteristics, BMI, comorbidities, depressive symptoms (hospital anxiety and depression scale) and pain level.

Fifteen percent of patients reported sometimes using opioids to manage chronic pain and another 15% reported daily use of opioids. Sometimes or daily use of opioids was reported in 40% of patients with spine OA, in 28% of those with knee OA and in 30% of those with hip OA.

Opioid use was significantly associated with spine OA, younger age, obesity, fibromyalgia, greater depressive symptoms, greater pain and other use of prescription pain medication.

“We found that those with the highest use also reported the highest levels of pain, suggesting that perhaps the opioids were not having their intended pain-reducing effect on all patients,” Rampersaud said in the release. “Our findings demonstrated that pre-surgical opioid use is an independent predictor of a greater degree of pain at 3 months post-surgery. Once we have determined the impact on other outcomes, such as perioperative adverse events, health care utilization and patient-reported outcomes, we aim to assess the efficacy of different pre-surgical pathways, including multimodality pain management strategies, that eliminate or reduce, in both dose and duration, opioid use in this population.”

Reference:
Power JD, et al. Abstract 2235. Presented at: American College of Rheumatology Annual Meeting; Nov. 3-8, 2017; San Diego.

Disclosures: The authors report no relevant financial disclosures.