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Home/Large Joints and Extremities/Pain IS Gone – Opioid Pill Popping Continues
Large Joints and Extremities

Pain IS Gone – Opioid Pill Popping Continues

June 22, 2016 1 min read Premium comments

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Pain IS Gone – Opioid Pill Popping Continues
Source: Wikimedia Commons and mpelletier1
Secondary

The surgery took place weeks ago. The pain from it is gone. So why are 53% of knee replacement patients and 35% of hip replacement patients still taking opioid painkillers? Some are still taking them six months following their surgery. New research has found that many patients continue to take opioids months after hip or knee surgeries despite the fact that their pain is largely gone.

Researchers studied the cases of 500 patients who underwent knee or hip replacement surgery. They examined the patients on the first, third and sixth month after the surgery to assess the potential devastating effects of the long-term use of prescription opioid painkillers.

They found that 30% of the patients were using addictive opioid painkillers before their surgery. Of this group, 53% of knee replacement patients and 35% of hip replacement patients were still taking opioid painkillers six months after their surgery. This is a major concern, according to the researchers, because the long term effect of use of addictive drugs can have devastating consequences.

Patients who had not been taking opioids prior to their surgery were less likely to report continued use of the drug. Among this group, only 4% of hip replacement patients and 8% of knee patients were still taking narcotics six months after the joint replacement. However, the patients did not reduce their long-term use of opioids even when their pain dramatically decreased following the surgery.

The study authors wrote, “Persistent opioid use after knee or hip replacement surgery may be more common than previously reported. Importantly, continued opioid use is not necessarily related to pain in the affected joint. We hypothesize that the reason patients continue to use opioids may be due to pain in other areas, self-medicating affective distress and therapeutic opioid dependence.”

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Discussion

14
DS
Dr. Sarah MitchellOrthopedic Surgeon · Mayo Clinic

This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?

8
JT
James Thornton, MDSpine Fellow · HSS

Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.

5
RP
R. PatelSports Medicine · Stanford

We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.

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