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Interdisciplinary Mitigation of Opioid Misuse in Musculoskeletal Patients

  • OPIOID PRESCRIBING AND PAIN MANAGEMENT / REVIEW ARTICLE
  • Published:
HSS Journal ®

Abstract

Background

The opioid prescribing patterns of orthopedic surgeons have been shown to play a role in exacerbating rates of opioid misuse among post-surgical patients. Demonstrable success has been appreciated by combining policy-level approaches and clinical education–based strategies to inform patients of alternative modalities of post-operative analgesia.

Questions/Purposes

The purpose of this review was to address two questions: What are the most substantiated measures orthopedic surgeons can take to limit opioid misuse or addiction among their patients? What advantages are gained in orthopedic surgeons’ collaborating with other healthcare professionals with influence over patients’ post-operative opioid exposure?

Methods

We searched two databases for articles on multidisciplinary policy–based solutions to mitigating the opioid overdose crisis among musculoskeletal patients. Articles produced from the search were searched for further evidence supporting the use of standardized clinical and administrative protocols in mitigating opioid misuse within this patient population. Successful approaches to mitigating misuse of opioids in this demographic were synthesized from recurring themes in the studies.

Results

Multiple articles support orthopedic surgeons being aware of the risk factors for chronic opioid use among their patients, as well as multidisciplinary strategies involving orthopedic surgeons and other healthcare/governmental professionals to address the burden of the opioid crisis on surgical patients.

Conclusions

Addressing the misuse of opioids among orthopedic patients requires appropriate prescribing practices and long-term support of patients. Collaboration between surgeons and policymaking entities is recognized as an effective population-wide approach to preventing opioid dependence, misuse, and addiction.

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References

  1. Bicket M, White E, Wu C, Pronovost P, Yaster M, Alexander G. Prescription opioid oversupply following orthopedic surgery: a prospective cohort study. J Pain. 2017;18(4):S34 [Abstract 232 presented at the 36th Annual Scientific Meeting of the American Pain Society].

    Article  Google Scholar 

  2. Bicket MC, White E, Pronovost PJ, Wu CL, Yaster M, Alexander GC. Opioid oversupply after joint and spine surgery. Anesth Analg. 2018. https://doi.org/10.1213/ane.0000000000003364

  3. Bockman C, Dale R, Dong J, et al. Examination of opioid discharge prescriptions, consumption and disposal in an orthopedic population. J Pain. 2017;18(4):S34 [Abstract 234 presented at the 36th Annual Scientific Meeting of the American Pain Society].

    Article  Google Scholar 

  4. Bot AG, Bekkers S, Arnstein PM, Smith RM, Ring D. Opioid use after fracture surgery correlates with pain intensity and satisfaction with pain relief. Clin Orthop Relat Res. 2014;472(8):2542–2549.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Buckenmaier CC. The role of pain management in recovery following trauma and orthopaedic surgery. J Am Acad Orthop Surg. 2012;20(Suppl 1):S35–S38.

    Article  PubMed  Google Scholar 

  6. Calcaterra SL, Yamashita TE, Min SJ, Keniston A, Frank JW, Binswanger IA. Opioid prescribing at hospital discharge contributes to chronic opioid use. J Gen Intern Med. 2016:31(5):475–485.

    Article  Google Scholar 

  7. Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131–157.

    Article  PubMed  Google Scholar 

  8. Cozowicz C, Olson A, Poeran J, et al. Opioid prescription levels and postoperative outcomes in orthopedic surgery. Pain. 2017;158(12):2422–2430.

    Article  PubMed  Google Scholar 

  9. Dautremont EA, Ebramzadeh E, Beck JJ, Bowen RE, Sangiorgio SN. Opioid prescription and usage in adolescents undergoing orthopaedic surgery in the United States. JBJS Reviews. 2017;5(8):e5.

  10. Doi K, Gibbons G, Shimoda R. Improving postoperative pain management in orthopedic total joint surgical patients with opioid tolerance using the Iowa model of evidence-based practice. J PeriAnesth Nurs. 2014;29(5):e38 [Abstract presented at the 2014 American Society of PeriAnesthesia Nurses National Conference].

    Article  Google Scholar 

  11. Finger A, Teunis T, Hageman MG, Ziady ER, Ring D, Heng M. Association between opioid intake and disability after surgical management of ankle fractures. J Am Acad Orthop Surg. 2017;25(7):519–526.

    Article  PubMed  Google Scholar 

  12. Gangavalli A, Malige A, Terres G, Rehman S, Nwachuku C. Misuse of opioids in orthopaedic postoperative patients. J Orthop Trauma. 2017;31(4):e103–e109.

    Article  PubMed  Google Scholar 

  13. Hah J, Bateman BT, Ratliff J, Curtin C, Sun E. Chronic opioid use after surgery: implications for perioperative management in the face of the opioid epidemic. Anesth Analg. 2017;125(5):1733–1740.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Hah J, Mackey SC, Schmidt P, et al. Effect of perioperative gabapentin on postoperative pain resolution and opioid cessation in a mixed surgical cohort: a randomized clinical trial. JAMA Surgery. 2018;153(4):303–311.

    Article  PubMed  Google Scholar 

  15. Helmerhorst GTT, Teunis T, Janssen SJ, Ring D. An epidemic of the use, misuse and overdose of opioids and deaths due to overdose in the United States and Canada. Bone Joint J. 2017;99-B(7):856–864.

    Article  CAS  PubMed  Google Scholar 

  16. Holman JE, Stoddard GJ, Higgins TF. Rates of prescription opiate use before and after injury in patients with orthopaedic trauma and the risk factors for prolonged opiate use. J Bone Joint Surg Am. 2013;95(12):1075–1080.

    Article  PubMed  Google Scholar 

  17. Inacio MC, Pratt NL, Roughead EE, Paxton EW, Graves SE. Opioid use after total hip arthroplasty surgery is associated with revision surgery. BMC Musculoskelet Disord. 2016;17:122.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  18. Kidd VD. Opioid prescribing in orthopaedic surgery: an evolving paradigm. JBJS Journal of Orthopaedics for Physician Assistants. 2018;6(1):e4.

    Google Scholar 

  19. Kumar K, Gulotta LV, Dines JS, et al. Unused opioid pills after outpatient shoulder surgeries given current perioperative prescribing habits. Am J Sports Med. 2017;45(3):636–641.

    Article  PubMed  Google Scholar 

  20. Levin P, Mir HR. The opioid epidemic: impact on orthopaedic surgery. J Am Acad Orthop Surg. 2015;23(9):e36–e37 [Letter].

    Article  PubMed  Google Scholar 

  21. Maheshwari AV, Blum YC, Shekhar L, Ranawat AS, Ranawat CS. Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center. Clin Orthop Relat Res. 2009;467(6):1418–1423.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Memtsoudis SG, Poeran J, Zubizarreta N, et al. Association of multimodal pain management strategies with perioperative outcomes and resource utilization. Anesthesiology. 2018;128(5):891–902.

    Article  PubMed  Google Scholar 

  23. Menendez M, Ring D, Bateman B. CORR Insights: Preoperative opioid misuse is associated with increased morbidity and mortality after elective orthopaedic surgery. Clin Orthop Relat Res. 2015;473(7):2413–2414.

    Article  Google Scholar 

  24. National Academies of Sciences, Engineering, and Medicine. Evidence on strategies for addressing the opioid epidemic. Pain management and the opioid epidemic: Balancing societal and individual benefits and risks of prescription opioid use. Washington, DC: The National Academies Press. Available from https://www.ncbi.nlm.nih.gov/books/NBK458653

  25. Nota SP, Spit SA, Voskuyl T, Bot AG, Hageman MG, Ring D. Opioid use, satisfaction, and pain intensity after orthopedic surgery. Psychosomatics. 2015;56(5):479–485.

    Article  PubMed  Google Scholar 

  26. Pasero C, McCaffery M. Orthopaedic postoperative pain management. J PeriAnesth Nurs. 2007;22(3):160–174.

    Article  PubMed  Google Scholar 

  27. Ring D, Sabharwal S. Opioids and orthopaedics in North America. J Bone Joint Surg Am. 2017;99(22):1881–1882.

    Article  PubMed  Google Scholar 

  28. Ruder J, Wally MK, Oliverio M, Seymour RB, Hsu JR, PRIMUM Group. Patterns of opioid prescribing for an orthopaedic trauma population. J Orthop Trauma. 2017;31(6):e179–e185.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Rummans TA, Burton MC, Dawson NL. How good intentions contributed to bad outcomes: the opioid crisis. Mayo Clin Proc. 2018;93(3):344–350.

    Article  PubMed  Google Scholar 

  30. Sinatra RS, Torres J, Bustos AM. Pain management after major orthopaedic surgery: current strategies and new concepts. J Am Acad Orthop Surg. 2002;10(2):117–129.

    Article  PubMed  Google Scholar 

  31. Soffin EM, Waldman SA, Stack RJ, Liguori GA. An evidence-based approach to the prescription opioid epidemic in orthopedic surgery. Anesth Analg. 2017;125(5):1704–1713.

    Article  PubMed  Google Scholar 

  32. Soneji N, Clarke HA, Ko DT, Wijeysundera DN. Risks of developing persistent opioid use after major surgery. JAMA Surg. 2016;151(11):1083–1084 [Research letter].

    Article  PubMed  Google Scholar 

  33. Sun EC, Darnall BD, Baker LC, Mackey S. Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period. JAMA Intern Med. 2016;176(9):1286–1293.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Ammar N. Saigal MD, MPH.

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Ammar N. Saigal, MD, MPH, and Henderson M. Jones, MD, JD, declare that they have no conflict of interest.

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Saigal, A.N., Jones, H.M. Interdisciplinary Mitigation of Opioid Misuse in Musculoskeletal Patients. HSS Jrnl 15, 72–75 (2019). https://doi.org/10.1007/s11420-018-09656-w

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  • DOI: https://doi.org/10.1007/s11420-018-09656-w

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