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Extremities Feature

Source: Wikimedia Commons and Rusty Frank

New Risk Factor for Opioid Overuse Discovered

Elizabeth Hofheinz, M.P.H., M.Ed. • Mon, August 28th, 2017

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Homing in on a specific surgery, physicians from the University of Iowa embarked on a study examining opioid use in rotator cuff patients. The article, “Opioid Consumption After Rotator Cuff Repair,” appears in the August 2017 edition of Arthroscopy.

Brian Wolf, M.D., M.S., co-author on the study and orthopedic surgeon with the University of Iowa, told OTW, “We examined whether patients were filling any opioid prescriptions within one month prior to surgery to account for those occasions when patients get prescriptions for surgery from the surgeon's office prior to the actual surgery date. We also looked at prescriptions that were filled between one month and three months prior to surgery. We compared both of these groups to patients that had not filled any prescriptions prior to surgery.”

The authors wrote, “All arthroscopic RCRs [rotator cuff repairs] performed between 2007 and 2014 were identified by use of Current Procedural Terminology code (29,827). Patients who filled opioid prescriptions preoperatively were divided into those who filled prescriptions at 1 to 3 months preceding RCR and those who filled opioid prescriptions only in the 1 month preceding RCR.”

Dr. Wolf told OTW, “We were very surprised to find that 43% of patients had filled a prescription for narcotic pain medicine prior to surgery. This was much higher than anticipated. The most important result was that patients that had filled narcotic/opioid prescriptions prior to surgery demonstrated a significant increase in the amount of prescriptions filled for opioid medications after surgery. This included not only patients that had filled a prescription within 1 month prior to surgery (~3.5 x more likely) but especially those patients that had filled prescriptions between 1 month and 3 months prior to surgery (~12 x more likely), as compared to patients that had not filled any prescriptions for narcotics prior to surgery.”

“Patient's filling prescriptions before surgery were several-fold more likely to be filling prescriptions after surgery all the way out to 1 year after surgery when the analysis was completed. A several-fold higher likelihood of filling narcotic pain medication prescriptions was seen every month after surgery. We also found the patient's with psychiatric diagnoses such as depression, fibromyalgia, and low back pain were at higher risk for filling prescriptions in the one-year after surgery.”

“The study suggests that it would be beneficial to get patients off any pain medications prior to surgery. Patients taking pain medication should be counseled that they will likely have more pain after surgery compared to others that were not already on pain medications. Surgeons may also want to make preemptive plans on how to deal with pain medications after rotator cuff surgery for patients already on medications before. That may include pain counseling, narcotic ‘contracts’ to solidify postoperative pain regimens and prescriptions, or deferring surgery until patients are off opioid medications for a period of time.”

“Surgeons should know that patients who have filled narcotic prescriptions prior to surgery are at much higher risk (3-12 x higher) of requesting and filling narcotic prescriptions for at least one year after surgery. This demonstrates that they are very difficult to get off narcotic pain medications compared to patients that were not using narcotic pain medicines prior to surgery. I think most surgeons understand this problem. But I think most surgeons would be surprised at how prevalent the problem actually is.”

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