Home E-Weekly May 30, 2017

Opioids and Orthopedics Don't Mix

Published: May 30, 2017

ALTERNATIVE THERAPY Patients should limit their use of opioids before knee replacement surgery.

Orthopedic surgeons need to consider opioid-sparing ways to manage their patients' joint discomfort before and after surgery, according to a pair of newly released studies. One show the pre-op use of opioids negatively impacts the pain patients experience after surgery. The other suggests that overprescribing the powerful painkillers to manage post-op pain could be contributing to the opioid crisis that's gripping the nation. A quick summary of both studies:

  • Patients who use opioids to manage chronic joint discomfort before knee replacement surgery are less likely to experience adequate pain relief after their procedures, according to research published in the Journal of Bone and Joint Surgery. Investigators at Brigham and Women's Hospital in Boston, Mass., reviewed the case outcomes of 156 patients who underwent total knee replacement. According to the study, 23% of the patients filled at least 1 opioid prescription before surgery. Patients who used opioids before surgery experienced about 9% less pain reduction in the 6 months following surgery than patients who did not use opioids.

    The researchers say surgeons need to consider the long-term consequences of opioid use and discuss the potential impact of using the painkillers to control osteoarthritis pain with patients who are considering undergoing total knee replacement within 2 years.

  • Most opioids prescribed following orthopedic procedures go unused, notes research published in the Journal of Pain. The study's authors, who presented their findings at the annual meeting of the American Pain Society, say 96% of 93 patients who underwent orthopedic procedures received at least 1 opioid prescription, with a majority of the products containing immediate release oxycodone. After a month, approximately two-thirds of the patients had completed the opioids therapy.

    Although the average patient used half of the 80 pills they were prescribed, three-fourths of the patients said they received "excellent" or "good" pain control. In addition, most of the patients kept the prescribed pills in an unlocked location, were unaware of the proper way to dispose of unused pills and, in fact, did not get rid of the excess medications. The findings highlight the importance of personalizing opioid prescriptions to individual patients in order to reduce the oversupply of the addictive painkillers in communities across America.

Daniel Cook

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