Correcting Nomenclature and Best Practices for Opioid Research

In part due to the opioid crisis, the issue of pain management has been increasingly on the radar of every orthopedic surgeon. Bemoaning the “pitfalls” seen when performing research with administrative data, a team of researchers has published findings from the Pain-Management Symposium, hosted by The Journal of Bone and Joint Surgery.

Their work, “Optimum Designs for Large Database Research in Musculoskeletal Pain Management,” was published in the May 20, 2020 edition of The Journal of Bone and Joint Surgery (JBJS).

Co-author Andrew J. Schoenfeld, M.D., M.Sc., deputy editor of JBJS, is with the Department of Orthopaedic Surgery at Brigham and Women’s Hospital and Harvard Medical School in Boston, Massachusetts.

Dr. Schoenfeld, along with his co-authors, aimed to outline the best study designs and directions for future research in this area. He explained the objective of the new study to OTW, “This work summaries a session in the NIH-funded [National Institutes of Health] pain management symposium conducted by The Journal of Bone and Joint Surgery and several other prominent orthopaedic journals in November 2019.”

“This work stems from the fact that given the prominence of opioid abuse and addiction, many researchers are trying to publish papers with an eye toward informing clinical practice in this realm. This paper was developed with the intent of helping those researchers looking to use large clinical datasets or registries for studies involving pain management and opioid use in orthopaedic surgery.”

Ditch terms like “opioid naïve” or “sustained”…

“Some of the more important features to come out of the symposium and discussed in the paper include the need to be more precise and uniform with language around opioid use and dependence before and after orthopaedic surgery. For example, terms like ‘opioid naïve’ are widely used and are imprecise. Researchers should try to avoid such a term whenever possible. Furthermore, there is wide variation in what constitutes ‘sustained’ prescription opioid use after a surgery, and we make a call for more uniform definitions in this context as well.”

Saying that not any dataset will do, Dr. Schoenfeld commented to OTW, “The paper offers a number of best practices for researchers using large datasets to study prescription opioid use and pain management in the context of orthopaedic procedures.”

“Researchers must be very familiar with the dataset they are using, the capabilities and limitations. The dataset should be selected to support the study question as opposed to formulating a study question that can be molded to the intricacies of the dataset. It is important to ensure that the datasets capture sufficient variation across race, ethnicity, socioeconomic status and pain management/prescription practices in order to ensure results can be generalized to the orthopaedic community. Many datasets used in prior studies do not possess all of these characteristics, however.”