Skip to main content

Acute Pain Is Associated With Chronic Opioid Use After Total Knee Arthroplasty.

Publication ,  Journal Article
Hsia, H-L; Takemoto, S; van de Ven, T; Pyati, S; Buchheit, T; Ray, N; Wellman, S; Kuo, A; Wallace, A; Raghunathan, K
Published in: Reg Anesth Pain Med
October 2018

BACKGROUND AND OBJECTIVES: Pain scores are routinely reported in clinical practice, and we wanted to examine whether this routinely measured, patient-reported variable provides prognostic information, especially with regard to chronic opioid use, after taking preoperative and perioperative variables into account in a preoperative opioid user population. METHODS: In 32,874 preoperative opioid users undergoing primary total knee arthroplasty at Veterans Affairs hospitals between 2010 and 2015, we compared preoperative and perioperative characteristics in patients reporting lower versus higher acute pain (scores ≤4/10 vs >4/10 averaged over days 1-3). We calculated the propensity for lower acute pain based on all available data. After 1:1 propensity score matching, to identify similar patients differing only in acute pain, we contrasted rates of chronic significant opioid use (mean >30 mg/d in morphine equivalents) beyond postoperative month 3, discharge prescriptions, and changes in postoperative versus preoperative dose categories. Sensitivity analysis examined associations with dose escalation. RESULTS: Rates of chronic significant opioid use (21% overall) differed in patients with lower versus higher acute pain (36% vs 64% of the overall cohort). After propensity matching (total n = 20,926 patients) and adjusting for all significant factors, lower acute pain was associated with less chronic significant opioid use (rates 12% vs 16%), smaller discharge prescriptions (ie, supply <30 days and daily oral morphine equivalent <30 mg/d), and more reduction in dose, all P < 0.001. In sensitivity analysis, dose escalation was 15% less likely with lower acute pain (odds ratio, 0.85; 95% confidence interval, 0.80-0.91). CONCLUSIONS: Acute pain predicts chronic opioid use. Prospective studies of efforts to reduce acute pain, in terms of long-term effects, are needed.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Reg Anesth Pain Med

DOI

EISSN

1532-8651

Publication Date

October 2018

Volume

43

Issue

7

Start / End Page

705 / 711

Location

England

Related Subject Headings

  • Retrospective Studies
  • Pain, Postoperative
  • Opioid-Related Disorders
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cohort Studies
  • Arthroplasty, Replacement, Knee
  • Anesthesiology
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Hsia, H.-L., Takemoto, S., van de Ven, T., Pyati, S., Buchheit, T., Ray, N., … Raghunathan, K. (2018). Acute Pain Is Associated With Chronic Opioid Use After Total Knee Arthroplasty. Reg Anesth Pain Med, 43(7), 705–711. https://doi.org/10.1097/AAP.0000000000000831
Hsia, Hung-Lun, Steven Takemoto, Thomas van de Ven, Srinivas Pyati, Thomas Buchheit, Neil Ray, Samuel Wellman, Alfred Kuo, Arthur Wallace, and Karthik Raghunathan. “Acute Pain Is Associated With Chronic Opioid Use After Total Knee Arthroplasty.Reg Anesth Pain Med 43, no. 7 (October 2018): 705–11. https://doi.org/10.1097/AAP.0000000000000831.
Hsia H-L, Takemoto S, van de Ven T, Pyati S, Buchheit T, Ray N, et al. Acute Pain Is Associated With Chronic Opioid Use After Total Knee Arthroplasty. Reg Anesth Pain Med. 2018 Oct;43(7):705–11.
Hsia, Hung-Lun, et al. “Acute Pain Is Associated With Chronic Opioid Use After Total Knee Arthroplasty.Reg Anesth Pain Med, vol. 43, no. 7, Oct. 2018, pp. 705–11. Pubmed, doi:10.1097/AAP.0000000000000831.
Hsia H-L, Takemoto S, van de Ven T, Pyati S, Buchheit T, Ray N, Wellman S, Kuo A, Wallace A, Raghunathan K. Acute Pain Is Associated With Chronic Opioid Use After Total Knee Arthroplasty. Reg Anesth Pain Med. 2018 Oct;43(7):705–711.

Published In

Reg Anesth Pain Med

DOI

EISSN

1532-8651

Publication Date

October 2018

Volume

43

Issue

7

Start / End Page

705 / 711

Location

England

Related Subject Headings

  • Retrospective Studies
  • Pain, Postoperative
  • Opioid-Related Disorders
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cohort Studies
  • Arthroplasty, Replacement, Knee
  • Anesthesiology