The Risk of Prior Opioid Exposure on Future Opioid Use and Comorbidities in Individuals With Non-Acute Musculoskeletal Knee Pain

Abstract

Objectives Due to their potentially deleterious effects, minimizing the use of opioids for musculoskeletal pain is a priority for healthcare systems. The objective of this study was to examine the risk of future opioid prescription use based on prior opioid use within a non-surgical cohort with musculoskeletal knee pain. We also examined the risk of pre-existing comorbidities on future opioid use, and the risk of prior opioid use on future comorbidities (sleep, mental health, cardiometabolic disorders). Methods Data came from the Military Health System Data Repository for 80 290 consecutive beneficiaries with an initial episode of care for patellofemoral pain from January 1, 2010 through December 31, 2011. Risk was calculated using 2 × 2 tables based on pre- and post-opioid utilization and comorbid diagnosis. Risk ratios, relative and absolute risk increases, and numbers needed to harm were calculated, all with 95% confidence intervals. Results Prior opioid use resulted in a risk ratio of 18.0 (95 CI 17.1, 19.0) and an absolute risk increase of 61.6% for future opioid use (numbers needed to harm = 2). The presence of all comorbidities (except cardiometabolic syndrome) were associated with a significant relative risk for future opioid use (RR range 1.2-1.5), but the absolute risk increase was trivial (range 0.7%-2.2%). The relative risk for a chronic pain diagnosis, traumatic brain injury/concussion, insomnia, depression, and PTSD were all significantly higher in those with prior opioid use (1.3-1.6), but absolute risk increase was minimal (1.1%-6.5%). Discussion Prior opioid use was a strong risk factor for future opioid use in non-surgical patients with knee pain. These findings show that history of prior opioid use is important when assessing the risk of future opioid use, whereas prior comorbidities may not be as important. Opioid history assessment should be standard practice for all patients with patellofemoral pain in whom an opioid prescription is considered.

Does Surgery for Cruciate Ligament and Meniscus Injury Increase the Risk of Comorbidities at 2 Years in the Military System?

“…However, similar criterion has been used to operationally define presence of comorbidities in this setting. 48 Lastly, we do not know the specifics or fidelity of the perioperative management or nonsurgical care provided, and how approaches during that period reflect current practice. These could influence comorbidities, especially those related to lifestyle changes.…”

Differences in Outcomes between Patellar Dislocations Managed in Emergent versus Non-Emergent Care Settings

“…Lastly, our sample had a very low level of comorbidities, much lower than those reported in past military-based studies involving cruciate ligament and meniscus injury, low back pain, and hip surgery. [15][16][17][18] A majority of comorbidities were represented in <1% of the total population, with only substance abuse and tobacco abuse disorders reaching 2%. Low levels of comorbidities may be reflective of better overall health in our sample compared with previous studies.…”

“…The study targeted patients who received care for a patella dislocation in the Military Health System. Consistent with previous studies, [15][16][17][18] we captured all patient care encounters 12 months before and 24 months after the initial diagnosis or surgery for every individual. The index date was the first date of diagnosis for a patellar dislocation.…”

Quickly identifying people at risk of opioid use disorder in emergency departments: trade-offs between a machine learning approach and a simple EHR flag strategy

“…We included comorbidity levels measured by the Charlson Comorbidity Index,27 history of alcohol use disorder, tobacco use disorder, mental illness, domestic violence and abuse, chronic pain and an indication of previous hospitalisation 24–26. An indicator for previous diagnosis of OUD was also ascertained from the EHRs 28. All clinical conditions were assessed in the 12-month baseline period and defined using previously validated algorithms from the Centers for Medicare and Medicaid Chronic Conditions Warehouse 29.…”

“…[24][25][26] An indicator for previous diagnosis of OUD was also ascertained from the EHRs. 28 All clinical conditions were assessed in the 12-month baseline period and defined using previously validated algorithms from the Centers for Medicare and Medicaid Chronic Conditions Warehouse. 29 We also used the EHR's prescription order data to assess previous use of analgesics, psychotropics, medications for OUD (MOUD) and opioids.…”