Participants were given pre-surgery questionnaires to collect data on their opioid usage. They were asked if they used opioids for pain never, sometimes or daily. They were also asked if they used other medications for arthritis or joint pain, such as non-steroidal anti-inflammatory drugs (NSAIDs), antidepressants or neuroleptics, and over-the-counter medications.
In addition to opioid use, variables in the questionnaire included age, sex and education level, body-mass index score, comorbidities, depressive symptoms according to the Hospital Anxiety and Depression Scale, and pain level measured on a 0-10 numeric scale for average pain experienced in the last week. The researchers used a multivariable logistic regression method to examine the associations between the patients' current reported opioid use with an outcome of sometimes/daily versus never and other variables.
The study's results showed that 15 percent of patients overall reported that they sometimes used opioids and an additional 15 percent reported daily use of these medications. Reported opioid use was highest among the spine OA patients at 40 percent and similar among knee and hip OA patients at 28 percent and 30 percent, respectively.
Women under the age of 65 reported the greatest overall opioid use, especially those with spine OA. The researchers also found that greater likelihood to use opioids was significantly associated with spine OA, younger age, obesity, the presence of fibromyalgia along with OA, greater depressive symptoms, greater pain and the current use of other prescription pain medications. The researchers concluded higher use of opioids among younger patients and those with greater depressive symptoms is especially concerning due to the possibility of opioid-related adverse effects.
"In both the U.S. and Canada, joint replacement and spine surgery for OA are the most common inpatient elective surgeries. Given the associated negative effects of opioids, we need to better understand the impact and means of mitigating adverse events associated with their use in end-stage OA, that is, the surgical population," said Dr. Rampersaud. "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. Given the relative lack of efficacy, the simplest answer is to not start them on opioids to begin with, and if necessary, to do so for short durations at the lowest possible dose. Our findings demonstrated that pre-surgical opioid use is an independent predictor of a greater degree of pain at three 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."