Factors associated with persistent opioid use after an upper extremity fracture

Abstract

Aims The increase in prescription opioid misuse and dependence is now a public health crisis in the UK. It is recognized as a whole-person problem that involves both the medical and the psychosocial needs of patients. Analyzing aspects of pathophysiology, emotional health, and social wellbeing associated with persistent opioid use after injury may inform safe and effective alleviation of pain while minimizing risk of misuse or dependence. Our objectives were to investigate patient factors associated with opioid use two to four weeks and six to nine months after an upper limb fracture. Methods A total of 734 patients recovering from an isolated upper limb fracture were recruited in this study. Opioid prescription was documented retrospectively for the period preceding the injury, and prospectively at the two- to four-week post-injury visit and six- to nine-month post-injury visit. Bivariate and multivariate analysis sought factors associated with opioid prescription from demographics, injury-specific data, Patient Reported Outcome Measurement Instrumentation System (PROMIS), Depression computer adaptive test (CAT), PROMIS Anxiety CAT, PROMIS Instrumental Support CAT, the Pain Catastrophizing Scale (PCS), the Pain Self-efficacy Questionnaire (PSEQ-2), Tampa Scale for Kinesiophobia (TSK-11), and measures that investigate levels of social support. Results A new prescription of opioids two to four weeks after injury was independently associated with less social support (odds ratio (OR) 0.26, p < 0.001), less instrumental support (OR 0.91, p < 0.001), and greater symptoms of anxiety (OR 1.1, p < 0.001). A new prescription of opioids six to nine months after injury was independently associated with less instrumental support (OR 0.9, p < 0.001) and greater symptoms of anxiety (OR 1.1, p < 0.001). Conclusion This study demonstrates that potentially modifiable psychosocial factors are associated with increased acute and chronic opioid prescriptions following upper limb fracture. Surgeons prescribing opioids for upper limb fractures should be made aware of the screening and management of emotional and social health. Cite this article: Bone Jt Open 2021;2(2):119–124.

Preoperative Predictors of Prolonged Opioid Use in the 6 Months Following Total Knee Arthroplasty

“…These same predictors, as well as past euphoric subjective opioid responses, predicted opioid use at 6 months (all of which represented daily opioid use). Several of these predictors replicate findings from prior studies, including catastrophizing, 5,15,16,29,30 anxiety, 24,30,31 and depression. 14,30 However, our results are inconsistent with findings from a recent single-center cohort study of similar size that only preoperative patient fatigue, but not pain catastrophizing, depression, or anxiety, were associated with the duration of subacute opioid use after total knee and hip arthroplasty.…”

“…11,[24][25][26] Central sensitization, which may drive postoperative pain intensity and chronicity, may also affect postoperative opioid use but has been little studied in this context. 27,28 Beyond preoperative opioid use and postoperative pain, prior prospective work has identified psychosocial factors associated with prolonged postoperative opioid use, including catastrophizing, 5,15,16,29,30 anxiety, 24,30,31 and depression. 14,30 These studies often comprise heterogeneous samples reflecting surgeries varying in degree of tissue trauma and expected postoperative pain course, potentially confounding interpretation.…”

PROMIS Depression and Anxiety in shoulder surgery patients

“…18,27,28 Increased anxiety and lack of social support has also been correlated with increased need for opiate therapy for pain control postoperatively. 29 Patients with increased social support were found to be more satisfied with their outcomes following brachial plexus surgery. 30 These findings highlight the importance of psychosocial factors on postoperative outcomes.…”

Are There Distinct Statistical Groupings of Mental Health Factors and Pathophysiology Severity Among People with Hip and Knee Osteoarthritis Presenting for Specialty Care?

“…Given the correlation between mental health and symptom intensity [52], one might assume that biomedical treatment that addresses osteoarthritis will decrease symptoms and improve symptoms of psychologic distress [17, 39], but there is evidence that operative treatment is not associated with more relief of depression symptoms than nonoperative treatment [11], and that preoperative depression symptoms are associated with less favorable recovery trajectories [20, 27]. There is ample evidence to suggest that performing elective procedures on patients with untreated or poorly controlled symptoms of distress (symptoms of anxiety and depression in particular) is associated with persistent pain and dissatisfaction [2, 12, 25, 38, 48]. On the other hand, there is insufficient evidence to suggest that biomedical treatment alone reduces emotional distress.…”

“…There is ample evidence to suggest that performing elective procedures on patients with untreated or poorly controlled symptoms of distress (symptoms of anxiety and depression in particular) is associated with persistent pain and dissatisfaction [2,12,25,38,48]. On the other hand, there is insufficient evidence to suggest that biomedical treatment alone reduces emotional distress.…”