Pain as a Predictor of Opioid Use Disorder in a Nationally Representative Sample

Misuse of prescription opioids among chronic pain patients suffering from anxiety: A cross-sectional analysis

OBJECTIVE

In the past two decades, chronic pain has been increasingly treated with prescription opioids, particularly in developed countries. This has drawn public concern of possible risks associated with the potential misuse of prescriptions opioids. Previous research has indicated that this may be particularly true among individuals suffering from co-occurring psychiatric disorders. The present study sought to explore rates of misuse among chronic pain patients prescribed opioids, comparing individuals with and without anxiety.

METHODS

Chronic pain patients receiving prescription opioids (N=554) were screened for anxiety using the Generalized Anxiety Disorder (GAD-7) scale and for opioid misuse using the Current Opioid Misuse Measure (COMM).

RESULTS

Among patients who screened positive for anxiety (GAD-7≥10), 50% also screened positive for opioid misuse, compared to 10% among those without anxiety. After controlling for possible confounding sociodemographic and clinical variables, patients with anxiety were significantly more prone to screen positive for opioid misuse (Adjusted Odds Ratio (AOR)=2.18; 95% Confidence Interval (CI)=1.37-4.17) compared to those without anxiety. This was maintained when conducting separate comparisons for severe, but not mild or moderate, level of anxiety.

CONCLUSIONS

These findings highlight the importance of detecting and addressing co-occurring anxiety when treating patients with chronic pain who receive prescription opioids.

Does Addition of Multimodal Periarticular Analgesia to Adductor Canal Block Improve Lengths of Stay, Pain, Discharge Status, and Opioid Use After Total Knee Arthroplasty?

BACKGROUND

Postoperative pain after total knee arthroplasty (TKA) can be burdensome. Multiple methods of pain control have been used, including adductor canal block (ACB) and multimodal periarticular analgesia (MPA). These two techniques have been studied have proven to be efficacious separately. The purpose of this study was to compare: (1) lengths of stay (LOS), (2) pain level, (3) discharge status, and (4) opioid use in TKA patients who received ACB alone vs patients who received ACB and MPA.

METHODS

A single surgeon database was reviewed for patients who had a TKA between January 2015 and April 2016. Patients who received ACB with or without MPA were included. This yielded 127 patients who had a mean age of 63 years. Patients were grouped into having received ACB alone (n = 52) and having received ACB and MPA (n = 75). Patient records were reviewed to obtain demographic and end point data (LOS, pain, discharge status, and opioid use). Student t test and chi-squared test were used to compare continuous and categorical variables respectively.

RESULTS

There were no significant difference in mean LOS (P = .934), pain level (P = .142), discharge status (P = .077), or total opioid use (P = .708) between the 2 groups.

CONCLUSION

There was no significant difference in LOS, pain levels, discharge status, and opiate requirements between the 2 groups. ACB alone may be as effective as combined ACB and MPA in TKA patients for postoperative pain control. Larger prospective studies are needed to verify these findings and to improve generalization.