Researchers Identify Psychosocial Factors That May Help Predict Prolonged Use of Opioids After Orthopaedic Surgery

Study Among Numerous Presentations by University of Maryland Orthopaedic Surgeons at American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting

SAN DIEGO – Psychosocial risk factors may be more important in predicting prolonged use of opioids by patients after orthopaedic surgery than the severity of the injury, a new study by researchers in the University of Maryland Department of Orthopaedics suggests. The study results will be presented this week at the American Academy of Orthopaedic Surgeons (AAOS) annual meeting in San Diego.

More than 180 patients at the University of Maryland R Adams Cowley Shock Trauma Center completed a survey six to 12 weeks after their injury. The researchers analyzed the responses and identified several factors such as pre-injury opioid use, educational level and fear of pain (pain catastrophizing) as the most important predictors of prolonged opioid use.

"The findings suggest that strategies aimed at identifying patients with psychosocial profiles that place them at high risk for extended use may be more important than focusing on patients with higher-severity injuries, the researchers conclude.

These patients were more likely to have a history of psychiatric disorder, have a high school education or less and have taken opioids within three months of their injury. They also were more likely to have a longer hospital stay and higher scores in regard to the severity of their injury, negative pain perceptions and depression.

"Extended opioid use after orthopaedic trauma places patients at risk of dependency, addiction and even overdose," notes the study's senior author, Robert V. O'Toole, MD, a professor of orthopaedics and division head of orthopaedic traumatology at the University of Maryland School of Medicine. "We sought to identify the most significant psychological, socio-demographic and injury characteristics associated with prolonged opioid use."

Dr. O'Toole, chief of trauma orthopaedics at the University of Maryland Shock Trauma Center, says larger longitudinal studies are needed to examine how various predictors of extended and chronic use of opioids overlap and whether interventions targeting those factors in early recovery could reduce dependency, addiction and overdose.

"There are no clear guidelines for providers on how to manage pain medications after severe traumatic injuries," says lead author Cullen Griffith, MD, a former orthopaedic trauma fellow at University of Maryland R Adams Cowley Shock Trauma Center, who is now practicing in Connecticut. "If we can provide physicians tools to help identify who is at higher risk of chronic opioid use in the trauma patient population it will allow for early intervention and the possibility for alternative therapies. Until we have an objective test we continue to depend on close attention to patient characteristics and subjective patient reporting."

Other presentations at AAOS by faculty members in the University of Maryland Department of Orthopaedics include:

• Research to determine whether vitamin D supplementation following a hip fracture improved physical function within two years of the injury. The study found a significant association between vitamin D use and long-term physical function scores. But, the researchers also noted substantial variation in patients' adherence to the prescribed supplementation plan. A new clinical trial will now seek to determine the most effective vitamin D dosing to help patients heal from fractures. Co-author M. Gerard-Paul Slobogean, MD, MPH, clinical assistant professor of orthopaedics at the University of Maryland School of Medicine, collaborated with researchers at McMaster University in Hamilton, Ontario, Canada, on the study.
• A study to determine if a novel surgical simulator developed by University of Maryland orthopaedic surgeons can distinguish between novice and experienced practitioners. Researchers recruited medical students, orthopaedic residents and attending surgeons to perform a common procedure on the simulator. Using various measures, they found that the simulator was able to distinguish between novice and experienced surgeons. The research lays the foundation for future studies now underway to assess the efficacy of the simulator for improving clinical performance. Study co-authors include Dr. O'Toole: Marcus A. Sciadini, MD, an associate professor of orthopaedics: and R. Frank Henn III, MD, an assistant professor of orthopaedics, at the School of Medicine.

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