Orthopedic surgery is associated with significant perioperative pain. Providing adequate analgesia is a critical component of patient care and opioids play a vital role in the acute postoperative setting. However, opioid prescribing for patients undergoing orthopedic procedures has recently been identified as a major contributor to the current opioid epidemic. As opioid usage and related morbidity and mortality continue to rise nationwide, opioid-prescribing practices are under increased scrutiny. Here, we update the evidence base and recommendations behind a set of interventions developed at the Hospital for Special Surgery to address the national epidemic at the local level. The main components of our program include (1) guidelines for managing patients who are opioid tolerant and/or have a substance abuse disorder; (2) education programs for patients, emphasizing the role of opioids in recovery after elective orthopedic surgery; (3) education programs for prescribers of controlled substances, including clinical and regulatory aspects; (4) the development of surgery-specific prescribing recommendations for opioid-naive patients; and (5) mechanisms to modify prescribing habits to limit unnecessary prescribing of controlled substances.

Objectives To examine preliminarily the effectiveness of a SMS text message-based social support intervention for reducing daily pain and pain interference levels, improving affect and perceptions of social support in patients with chronic non-cancer pain, and exploring the feasibility of a novel mobile application to track perceptions of pain and pain-interference. Materials and Methods Participants (17 men, 51 women) from two pain clinics in New York City downloaded a pain tracking App to their smartphone and employed it to record twice-daily pain, pain interference, and affect scores over the 4-week study period. Participants were randomly assigned to receive standard care (control) or standard care along with receipt of twice-daily supportive SMS text messages delivered during the 2nd and 3rd week of the study (intervention). Demographic and clinical data were obtained at baseline, and social support measures were administered at baseline and at 4-weeks. Statistical analysis was carried out using general linear mixed models taking into account variances associated with time of assessments and with patients. Results The social support intervention reduced perceptions of pain and pain interference and improved positive affect for chronic non-cancer pain patients assigned to the intervention condition in comparison to controls. Participants completed approximately 80% of the daily measurements requested. Discussion These findings establish the feasibility of collecting daily pain data using a mobile tracking App and provide significant implications and insight into a nuanced approach to reducing the daily experience of pain via mobile technology, especially because of its accessibility.

Post-operative ileus is multifactorial in origin, and this study identified intra-operative hydromorphone and post-operative crystalloid fluid administration ≥2 litres as independent risk factors for the development of ileus.