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Nearly 1 in 3 Pre-surgery Patients With OA Use Opioids
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As many as 30% of presurgical patients with end-stage knee, hip or spine osteoarthritis use prescription opioids, according to data published in Arthritis Care & Research.
“A large proportion of the population has OA, and from a societal perspective, the use of opioids for OA has the potential to have a significant impact on the number of opioids in circulation,” J. Denise Power, PhD, of the Krembil Research Institute at the University Health Network, in Toronto, told Healio Rheumatology. “For the individual patient, in addition to risks of dependence and addiction, there is also increasing evidence that opioids may be no more effective in relieving OA pain than NSAIDs. For surgical patients, opioid use before surgery may negatively impact outcomes and increase the risk of adverse events.”
To analyze prescription opioid rates among presurgical patients with knee, hip or spine OA, as well as the links between opioid use and demographics and health status, Power and colleagues conducted a cross-sectional, retrospective study of baseline data from the ongoing Longitudinal Evaluation in the Arthritis Program (LEAP-OA). Participants in that cohort are patients with OA who are scheduled for orthopedic surgery, recruited from the Toronto Western Hospital. For their own analysis, the researchers focused on 577 patients with knee, 459 with hip and 168 with spine OA, recruited between November 2013 and January 2017.
Participants completed a questionnaire within 3 weeks prior to their scheduled surgery, providing information on current opioid and other pain medication use, as well as socio-demographic, health status, pain and depression information. Power and colleagues determined the rates of opioid use based on sex, age and surgical site. In addition, they used multivariable logistic regression to analyze the relationship between opioid use and other variables.
According to the researchers, 15% of included patients said they used opioids “sometimes,” while 15% reported “daily” use. Among patients with spine OA, 40% reported using opioids, compared with 30% of those with hip OA and 28% among the knee OA group. Women younger than 65 years with spine OA reported the highest opioid usage rate of all groups, at 61.3%.
Following multivariable logistic regression, the researchers found that a greater likelihood of opioid use was significantly associated with spine OA — compared with knee OA — as well as obesity, current or prior smoking, higher symptomatic joint count, greater depressive symptoms, greater pain and current use of other prescription pain medication.
“Our findings raise questions as to the appropriateness of current usage patterns and highlights the need for more specific guidance,” Power said. “Translation of such recommendations to primary care physicians is of particular importance, as this is where the vast majority of OA is currently managed.”
“Our findings also suggest that addressing patient factors such as depression, smoking and obesity may be beneficial to reducing opioid use, in addition to their positive impacts on patients’ overall health,” Power added. “As evidence continues to build that opioid use may negatively impact surgical outcomes, optimized preoperative pain management and consideration of presurgical opioid use screening including potential dependency may also be warranted for patients undergoing surgery for OA.” – by Jason Laday
Disclosure: The researchers report financial support from the Toronto General & Western Hospital Foundation. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Eileen McCullagh, BSN, RN, ONC, CCRC
OA pain is one of the most painful pain modes. With only a limited number of published studies of opioid use in pre-operative OA-related procedures, this study contributes to the growing body of literature examining opioid use in chronic pain populations. This is a timely subject to study considering the agreement in the medical community of an opioid crises along with the general lack of consensus from professional medical organizations around the appropriate use of opioids and general guidelines in OA pain management.
This study found that nearly one-third of the pre-surgical patients with hip, knee and spine OA currently used opioids, with the spine patients representing the most opioid use. The smaller sample size of spine patients compared to hip and knee patients in this study may have contributed to this finding and future research will need to add more spine patients to confirm this finding.
Findings of greater use in younger individuals with OA and among those with greater depressive symptoms raise more questions on the appropriateness of current opioid patterns and the need for more guidance. Guidance for primary care physicians is of particular importance since the majority of OA is currently managed at this level. Additional research is needed on pre-operative pain management in OA and will hopefully lead to better screening of potential dependency on opioids in this population.
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