Post-traumatic Stress Disorder as an Independent Risk Factor for Increased Opioid Use Following Carpal Tunnel Surgery

Abstract

Background: Carpal tunnel release (CTR) is one of the most common hand surgeries. Studies have highlighted a mental-physical connection to hand pathologies and psychological connections to postoperative pain burden. Post-traumatic stress disorder (PTSD) has been identified as a medical-psychological comorbidity like other mental health disorders such as generalized anxiety disorder (GAD). There remains a gap in the literature regarding PTSD as a comorbidity for hand surgeries, where there is this mental-physical connection. We hypothesize PTSD will be associated with increased risk of postoperative pain, evidenced by greater prevalence of opioid usage. Methods: The authors performed a retrospective analysis using the TriNetX Research Database. Patients who underwent elective CTR were identified within the database. Two groups were created and compared against individual controls: the first was identified based on the diagnosis of PTSD, and the second was identified based on the diagnosis of GAD. Cohorts were matched and opioid usage was compared postoperatively. Results: Patients with PTSD who underwent CTR were found to be at significantly increased risk of postoperative opioid use ( P = .033) and more likely to present to the emergency department (ED) ( P = .001). Patients with GAD were found to be significantly less likely to require postoperative opioids ( P = .040). Conclusions: We found patients with PTSD to be at increased risk of opioid use and more likely to present to ED following CTR. Patients with GAD were found to be at decreased risk of opioid use after CTR. Owing to the independent significant risks not found in GAD, further research of postoperative pain in patients with PTSD is needed.

Overuse of the psychoactive analgesics’ opioids and gabapentinoid drugs in patients having surgery for nerve entrapment disorders

“…Posttraumatic stress disorder is also described as an independent risk factor for increased use of opioids after surgery for CTS. In contrast, patients with a generalized anxiety disorder have shown a decreased risk for opioid use after such surgery 32 . Other patient characteristics, such as age, sex, ethnicity, having a private insurance, psychological disorders, previous pain diagnosis, history of drug abuse, lower income, low socioeconomic status, mental health disorders, and higher doses, have also been highlighted for postoperative opioid prescription among hand surgeons 18 , 28 , 33 , which was confirmed in our study.…”