Kentucky Doc Spring 2016 - Page 13

doc Spring 2016 • Kentucky shoulder arthroplasty in patients with a history of preoperative opioid use for shoulder arthritis. Preoperative opioid was associated with significantly worse preoperative and postoperative shoulder function scores relative to patients without a history of preoperative opioid use.8,9 Patients with preoperative opioid use can respond very well to shoulder replacement surgery, but it has been shown that they do not reach the same level of improvement compared to nonopioid patients. Furthermore, patients without preoperative opioid use have been shown to have significantly better postoperative patient satisfaction after total shoulder arthroplasty compared to patients with preoperative opioid use.8 The American Academy of Orthopaedic Surgeons (AAOS) recently issued a position statement in response to the rise in opioid prescribing to help guide physicians that manage musculoskeletal conditions.10 The AAOS recognized the need for physicians to manage musculoskeletal pain, while understanding the direct and indirect contributions to the opioid burden in the United States. The AAOS called for a culture change among physicians, patients, and caregivers regarding opioid prescribing and pain control in musculoskeletal conditions. Proposals included standardized opioid prescribing protocols, limits on the duration and amount of opioid pills prescribed, and avoiding the use of extended-release opioids. The AAOS recommended avoiding opioids for the routine management of pre-surgical pain, nonoperative, or chronic musculoskeletal conditions. Objective risk assessment tools were suggested to help better identify patients at risk for greater opioid use as well as opioid use tracking. Improved care coordination and physician collaboration was recommended. Orthopaedic surgeons and other musculoskeletal specialists can help to better communicate and collaborate with primary care physicians and other specialties regarding the treatment of musculoskeletal conditions. The negative consequences of nontherapeutic opioid use are apparent. The detrimental effects of therapeutic opioid use, especially in the management of musculoskeletal conditions, are now more clearly identified. Additional work is needed to better understand and treat pain associated with musculoskeletal conditions. The association between therapeutic opioid use and worse patient outcomes has been highlighted. Additional efforts are needed to explore the complexities of pain and outcomes in the management of these common conditions. About the Author Brent J. Morris, MD is an orthopedic surgeon and fellowship-trained shoulder and elbow specialist at Lexington Clinic Orthopedics Sports Medicine Center and the Shoulder Center of Kentucky. Dr. Morris received his medical degree from the University of Kentucky College of Medicine and completed an orthopedic surgery residency at Vanderbilt University. He completed a shoulder and elbow fellowship at Texas Orthopedic Hospital in affiliation with the University of Texas Health Science Center at Houston. Dr. Morris has presented research nationally and internationally and has published extensively on various orthopedic topics including the impact of opioids on orthopedic patients. Resources 1. Manchikanti L, Singh A: Therapeutic opioids: A ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Pain Physician 2008;11(2 suppl):S63-S88. 2. Daubresse M, Chang HY, Yu Y, Viswanathan S, Shah ND, Stafford RS, Kruszewski SP, Alexander GC. Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000-2010. Med Care 2013;51(10):870-878. 3. Manchikanti L, Helm S II, Fellows B, Janata JW, Pampati V, Grider JS, Boswell MV. Opioid epidemic in the United States. Pain Physician 2012;15(3 suppl):ES9-ES38. 4. Zywiel MG, Stroh DA, Lee SY, Bonutti PM, Mont MA. Chronic opioid use prior to total knee arthroplasty. J Bone Joint Surg Am 2011;93(21):1988-1993. 5. Lee D, Armaghani S, Archer KR, Bible J, Shau D, Kay H, Zhang C, McGirt MJ, Devin C. Preoperative opioid use as a predictor of adverse postoperative self-reported outcomes in patients undergoing spine surgery. J Bone Joint Surg Am 2014;96(11):e89. 6. Armaghani SJ, Lee DS, Bible JE, Shau DN, Kay H, Zhang C, McGirt MJ, Devin CJ. Increased preoperative narcotic use and its association with postoperative complications and length of h