Patients With Major Depressive Disorder Experience Increased Perception of Pain and Opioid Consumption Following Total Joint Arthroplasty

Etcheson, Jennifer I.; Gwam, Chukwuweike U.; George, Nicole E.; Virani, Sana; Mont, Michael A.; Delanois, Ronald E.

doi:10.1016/j.arth.2017.10.020

Cited by 65 publications

(40 citation statements)

References 30 publications

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“…Finally, it is also possible that some patients may adjust their PROMIS answers based on the provider type they are scheduled to see. For instance, depression has been linked to poor postoperative outcomes after multiple orthopedic and other medical procedures, and some patients who desire surgery may underreport depression symptoms to surgeons out of fear that a high Depression score will reduce their likelihood of being offered surgery. This hypothesis alone, though, would not explain why PROMIS emotional health scores were worse in physiatry patients than in other nonsurgical patients.…”

Section: Discussionmentioning

confidence: 99%

PROMIS Physical and Emotional Health Scores Are Worse in Musculoskeletal Patients Presenting to Physiatrists than to Other Orthopedic Specialists

Cheng

Calfee

Colditz

et al. 2019

PM&R

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Background: Physiatrists' unique training in person-centered biopsychosocial management of complex problems may influence musculoskeletal patients' expectations and self-and/or physician-referral patterns to physiatrists. Consequently, average patient complexity and need for multi-disciplinary services may be increased in physiatric patients. Objective: To compare musculoskeletal patients' self-reported physical and emotional health according to provider specialty. Researchers tested the null hypothesis that there is no significant difference in Patient-Reported Outcomes Measurement Information System (PROMIS) scores between patients who present to physiatrists in comparison to other musculoskeletal specialists. Design: Cross-sectional study. Setting: Orthopedic department of a tertiary academic medical center. Patients: Participants included 31 791 new adult patients (mean age 52.6 AE 16.2 years) who presented for initial elective evaluation of a musculoskeletal problem by an orthopedic surgeon or sports medicine trained emergency medicine, family medicine, pediatric, or physiatric physician. Methods: Patients completed the PROMIS computer adaptive test (CAT) Physical Function, Pain Interference, Anxiety, and Depression domains at department check-in prior to the physician encounter. Score differences by provider type were assessed using Wilcoxon rank-sum tests. Main Outcome Measurements: Mean PROMIS score in each domain subdivided by physiatric, surgical, and other nonsurgical provider type. Results: In total, 2081 patients presented to physiatrists, 28 267 presented to surgeons, and 1443 presented to other nonsurgical providers. For each respective provider type, average PROMIS scores were Physical Function 38.9 AE 8.2, 41.5 AE 9.5, and 43.5 AE 8.2; Pain Interference 62.6 AE 7.2, 60.9 AE 7.7, and 59.2 AE 6.8; Anxiety 54.5 AE 10. 4, 51.9 AE 10.6, and 49.8 AE 9.8; and Depression 49.3 AE 10.4, 47.0 AE 10.0, and 44.2 AE 8.7. Physiatric patients had significantly worse average scores for all domains compared to surgical (P < .001) and other nonsurgical patients (P < .001). Conclusions: Average PROMIS Physical Function, Pain Interference, Anxiety, and Depression scores were worse in musculoskeletal patients who presented to physiatrists in comparison to surgical or other nonsurgical providers. This suggests that some patients who choose to see or are referred to see physiatrists may have more or be more willing to endorse having biopsychosocial impairments.

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Section: Discussionmentioning

confidence: 99%

PROMIS Physical and Emotional Health Scores Are Worse in Musculoskeletal Patients Presenting to Physiatrists than to Other Orthopedic Specialists

Cheng

Calfee

Colditz

et al. 2019

PM&R

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“…Numerous studies have demonstrated that psychological factors predict or are associated with opioid use (reviewed by Darnall et al) [43]. Depression preceding lumbar fusion or total joint arthroplasty is associated with increased opioid use following surgery [44,45]. Psychological factors, such as unstable mental illness, and higher depression rates than in controls, have been associated with opioid prescription and use in FM [37,41].…”

Section: Narcotic Drugs Prescription and Depressionmentioning

confidence: 99%

Characteristics of fibromyalgia patients prescribed opioid medications: data from the Cleveland clinic fibromyalgia registry

Kaouk¹,

Wilke²,

Gota³

2018

Int. J. Clin. Rheumatol

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Objective: Determine the prevalence, socioeconomic, clinical characteristics of fibromyalgia (FM) patients and the factors associated with narcotic drug prescription. Methods: New patients with FM referred for rheumatology evaluation are compared based on narcotic drugs use. Demographic, socioeconomic, clinical, and medication data are collected. Results: Of 305 FM patients 34.8% are taking narcotic medication and these patients (p ≤ 0.05) are older, have longer duration of FM, are socioeconomically more disadvantaged by lower education and employment and higher disability rates; more are obese, and clinically report more extensive and severe pain, higher depression, more disability and higher FM severity, compared to FM patients not prescribed opioid drugs. Patients prescribed opioids are using more medical resources, they take more medications for FM and report more doctor visits and surgeries. Binomial regression analysis demonstrates that pain and stiffness severity, and functional impairment are independent predictors of being prescribed opioid medications. Taking narcotic medications is an independent predictor of FM severity along with pain and depressive symptoms. Conclusion: About one third of patients with FM seen in a tertiary care rheumatology center are taking narcotic medications to treat pain. In this environment, opioid prescription for FM identifies a group of patients with severe FM who have failed the traditional therapeutic options. Characteristics of fibromyalgia patients prescribed opioid medications: Data from the Cleveland Clinic Fibromyalgia registry Research Article more than a month but less than a year, and a year or more.

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“…Although PG surveys have been used as a metric for patient satisfaction, they have increasingly been shown to be a poor indicator of what they purport to measure. In another study, Etcheson et al 22 retrospectively reviewed 129 TKA patients to compare patient perception of pain with opioid consumption in patients with and without major depressive disorder (MDD). They reported increased opioid consumption in patients with MDD (p ¼ 0.038) but no difference in PG survey responses despite a higher mean pain intensity score among MDD patients (MDD ¼ 214.8 vs. control ¼ 185.1).…”

Section: Discussionmentioning

confidence: 99%

Pain Intensity: How Press Ganey Survey Domains Correlate in Total Knee Arthroplasty Patients

et al. 2018

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Decreasing postoperative pain for total knee arthroplasty (TKA) patients has been an area of continued effort for healthcare providers. These efforts have been incentivized by legislative reform, which ties reimbursement for hospitals and providers to patient perception of care. Press Ganey (PG) surveys quantify patient satisfaction, and the “pain management” domain is thought to be the best metric for assessing pain intensity. Therefore, these responses are important, as they are used to guide further improvements in healthcare delivery. This study analyzes which PG survey domains are truly associated with pain intensity in the immediate postoperative period following TKA. We queried our PG database for all primary TKA patients between November 2012 and January 2015, yielding a total of 214 patients. Multivariate regression analysis was performed utilizing pain intensity as the dependent variable. Predictor variables included body mass index (BMI), Charlson's comorbidity index, opioid consumption, and PG survey domains. Patient ratings of “communication with doctors” (B = 58.147; p = 0.001), “responsiveness of hospital staff” (B = − 62.663; p = 0.041), “communication about medicines” (B= −45.037; p < 0.001), and “hospital environment” (B = 69.342; p = 0.017) were associated with patient pain intensity. We found survey domains, other than “pain management,” were associated with pain intensity. Efforts to improve outcomes and satisfaction should focus on staff education and communication. The current method for measuring patient satisfaction and reimbursement should be critically assessed and redesigned to better reflect true patient experiences.

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Patients With Major Depressive Disorder Experience Increased Perception of Pain and Opioid Consumption Following Total Joint Arthroplasty

Cited by 65 publications

References 30 publications

PROMIS Physical and Emotional Health Scores Are Worse in Musculoskeletal Patients Presenting to Physiatrists than to Other Orthopedic Specialists

PROMIS Physical and Emotional Health Scores Are Worse in Musculoskeletal Patients Presenting to Physiatrists than to Other Orthopedic Specialists

Characteristics of fibromyalgia patients prescribed opioid medications: data from the Cleveland clinic fibromyalgia registry

Pain Intensity: How Press Ganey Survey Domains Correlate in Total Knee Arthroplasty Patients

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