A Multidisciplinary Transitional Pain Management Program Is Associated With Reduced Opioid Dependence After Primary Total Joint Arthroplasty

• Published in: The Journal of arthroplasty 2022-06, Vol.37 (6), p.1048-1053
• Main Authors: Featherall, Joseph, Anderson, Joshua T., Anderson, Lucas A., Bayless, Kimberlee, Anderson, Zachary, Brooke, Benjamin S., Gililland, Jeremy M., Buys, Michael J.
• Format: Article
• Language: English
• Subjects: Aftercare; Analgesics, Opioid - therapeutic use; Arthroplasty; chronic opioid use reduction; Humans; multimodal pain management; opioid epidemic; opioid sparing pain control; Opioid-Related Disorders - prevention & control; Pain Management; Pain, Postoperative - drug therapy; Patient Discharge; perioperative pain management; Prospective Studies; Retrospective Studies
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2022.02.032

Overprescription of opioids after total joint arthroplasty (TJA) increases risks of opioid dependence, overdose, and death. The authors hypothesized that a multidisciplinary, perioperative pain management program (the Transitional Pain Service or TPS) for TJA would lead to fewer patients becoming opioid dependent. A TPS was implemented at a Veterans Affairs Medical Center focused on nonopioid pain management, cessation support, and prospective data tracking. A historical control, interventional study design was used to assess opioid use at 90 days post-discharge. Secondary analysis of the implementation group included post-operative outcome scores, time to opioid cessation, and median opioid tablets consumed at 90 days. Fewer patients in the TPS group demonstrated persistent opioid use at 90 days post-discharge (0.7% vs 9.9%; P = .004). Independent predictors of total opioid tablet prescriptions included TPS (β = −19.41; 95% confidence interval [CI] −35.37 to −3.47), number of tablets prescribed at discharge (β = 1.08; 95% CI 0.86-1.31), and TKA surgery (β = 16.84; 95% CI 4.58-29.10). Under the TPS, median tablets consumed was 20.5 for THA and 36.5 for TKA; median time to cessation was shorter in THA (7 days; 95% CI 2-10) when compared to TKA (13 days; 95% CI 11-16). In opioid-naïve veterans undergoing TJA, the TPS was associated with a 93% reduction in opioid dependence and a 60% reduction in opioid tablet prescriptions at 90 days post-discharge. Under the TPS, median 90-day opioid consumption was 20.5 and 36.5 tablets for THA and TKA, respectively. Widespread adoption of similar programs may greatly reduce opioid use and dependence in orthopedic patients nationally. III.