Use of prescription analgesic medication and pain catastrophizing after total joint replacement surgery
Abstract
Objective To survey the use of analgesic medication 4.8 years after total joint replacement (TJR) surgery and assess the determinants of medication usage.Patients and methods Of 852 patients who had undergone TJR for osteoarthritis were recruited from secondary care. Participants (mean age, 73.7 years) responded to a questionnaire on medication use, physical function and pain (WOMAC, VAS and body pain), pain catastrophizing and illness behaviour (somatization).Results Only 37% of study participants were not on any pain relief medication, 25.1% were taking opioids, 6.9% were taking prescription NSAIDs and 25.9% were taking only non-prescription analgesics. Use of NSAIDs correlated with presence of back pain, body pain and high illness behaviour. The strongest associations with use of opioids were severe joint pain, high pain catastrophizing, body and back pain. After adjustment for covariates plus presence of pain, catastrophizing remained significantly associated with higher risk of opioid use (OR = 1.66, 95% CI: 1.13-2.43, p < 0.009) and of other prescription medication that can be used to treat pain (anti-depressants, anti-epileptics and hypnotics) (OR = 2.52, 95% CI: 1.61-3.95, p < 0.0005).Conclusions Use of opioid medication 4 years post-TJR is very high in our study population. In addition to joint, back and body pain, a major contributor to opioid use is pain catastrophizing. Our data suggest that current opioid and other analgesic prescribing patterns may benefit from considering the catastrophizing characteristics of patients.
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The higher pain catastrophizing in survivors with persistent breast pain is consistent with prior studies of persistent pain after breast cancer surgery and broader persistent post-surgical pain.
“The higher levels of pain catastrophizing we found in breast cancer survivors with PBP compared to those without PBP are consistent with prior studies of persistent pain following breast cancer surgery, as well as with studies of persistent post-surgical pain more broadly [36, 37].”
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- Authors
- Valdes, A. M., Warner, S. C., Harvey, H. L., Fernandes, G. S., Doherty, S., Jenkins, W., Wheeler, M., & Doherty, M.
- Affiliations
- University of Nottingham (GB)
- Nottingham City Hospital (GB)
- Corresponding author
- Valdes, Ana M.
- Venue
- Seminars in Arthritis and Rheumatism
- Publisher
- Elsevier BV
- Published
- 2015-10
- Volume
- 45
- Issue
- 2
- Pages
- 150-155
- ISSN
- 0049-0172 (ISSN-L)
- OpenAlex
- W1901587384
- Cited by
- 28
- References
- 27
- Citations by year
- 2024: 1 · 2023: 5 · 2022: 1 · 2021: 2 · 2020: 7 · 2019: 1 · 2018: 5 · 2017: 4 · 2016: 2
- FWCI
- 4.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Seminars in Arthritis and Rheumatism (publishedVersion)
- PubMed (publishedVersion)
- Explore Bristol Research (publishedVersion)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- total joint arthroplasty, pain catastrophizing, opioid use, prescription analgesics, osteoarthritis, chronic drug administration, nonsteroidal anti-inflammatory drugs, back pain, somatization, antidepressants, hypnotics, analgesic prescribing
- MeSH terms
- Aged, Aged, 80 and over, Analgesics, Female, Humans, Male, Middle Aged, Osteoarthritis, Pain Measurement, Pain, Postoperative, Postoperative Pain, Treatment Outcome, Arthroplasty, Replacement, Catastrophization
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