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Help with coping strategies may minimise the need for opioids after ankle surgery

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Patients who are given support to help manage stress and improve their coping strategies may have less need for opioids following ankle fracture surgery, according to new research.

In a study published in the the Journal of the American Academy of Orthopaedic Surgeons, researchers sought to determine if opioid intake was associated with disability, satisfaction with surgery and pain relief — both at the time of suture removal (one to two weeks after surgery) and at the follow-up appointment, between five and eight months later.

At the time of suture removal and at the follow-up appointment, no association was found between opioid intake and disability, satisfaction with the surgery or satisfaction with pain management.

Opioid use was independently associated with more reported pain with activity, as well as greater catastrophic thinking (excessive worry/rumination leading to anxiety and preventing patients from taking proactive steps to ease pain and discomfort), at suture removal and at follow-up appointments.

The researchers also found that greater disability (limited mobility) was associated with catastrophic thinking and a poor response to the surgery and pain.

In total, 83% of patients were using opioids at the time of suture removal. That number decreased to 24% at the follow-up appointments.

“Opioid-centric pain relief strategies have led to safety concerns without adequately relieving pain,” commented lead study author Dr David Ring, associate dean of comprehensive care and professor of surgery and perioperative care at the Dell Medical School at the University of Texas. “This is the latest in a series of studies demonstrating that pain relief after surgery or injury has more to do with calm and reassurance (self-efficacy) than with medication. Getting comfortable seems mostly about giving your body time to heal.”

The study authors said that their findings “demonstrate the need for a comprehensive approach to pain relief after surgery, including optimisation of the patient’s mindset and circumstances (with effective coping strategies being most important) in addition to the use of analgesics, elevation, ice, and other physical strategies.”

http://newsroom.aaos.org/media-resources/Press-releases/reducing-stress-optimizing-coping-strategies-may-diminish-need-for-opioids-following-ankle-surgery.htm

http://journals.lww.com/jaaos/Abstract/2017/07000/Association_Between_Opioid_Intake_and_Disability.6.aspx