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Opioid use before knee surgery linked to worse pain outcomes

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In a new study, patients who took opioids to manage their knee pain before knee replacement surgery obtained less pain relief from the operation.

A team of investigators at Brigham and Women’s Hospital in Boston evaluated pain relief associated with total knee arthroplasty (TKA) in patients who had used opioids before their procedure and compared it to pain relief in patients who had not.

A total of 156 patients were included in the analysis, all of whom underwent TKA between 2011 and 2013. The average age was about 66 years and 62% of patients were women. Average pain score before surgery was about 44 on a 100-point scale, with 100 being the worst score.

During the two years before surgery, 23% of patients had received at least one prescription for opioid pain relievers, and 9% had multiple opioid prescriptions. (Nearly all patients received opioids for pain relief after surgery.)

Six months after TKA, pain scores and other outcomes were compared for patients with and without previous opioid prescriptions. The analysis included a “propensity score” to account for other factors associated with an increased likelihood of using opioids.

Results showed that after surgery, the previous opioid users had a higher average pain score: about 17, compared to 10.5 for those who did not receive opioids. The difference in postoperative pain-score reduction between the two groups was significant after adjusting for preoperative pain score and other health conditions, the researchers said.

The factor most strongly related to preoperative opioid use was an elevated score for “pain catastrophising” — the degree to which a person has exaggerated negative responses to and worries about pain. According to the study authors, pain catastrophising may play an important role in decisions by medical practitioners and patients to use opioids, which then places patients at risk for poorer outcomes.

“With these study results, we’d encourage physicians to consider discussing long term implications of opioid therapy with their patients,” commented Elena Losina, PhD, of the Department of Orthopaedic Surgery at Brigham and Women’s Hospital. “Although each patient case is different, patients and physicians should discuss the potential impact of using opioids in patients with knee osteoarthritis who are likely to consider total knee replacement within the next two years.”

The findings have been published in the Journal of Bone and Joint Surgery.