MedicalResearch.com Interview with:
MD Candidate – Class of 2018
University of Massachusetts Medical School
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Over 1 million patients undergo total joint replacement surgery in the United States alone every year, with many experiencing significant pain postoperatively. These procedures often require large amounts of pain medication to keep patients comfortable, which historically has been treated with opioids. Currently, increasing awareness of safe opioid prescribing has created an increased interest in other ways to effectively treat post-operative pain without the dangers and side-effects of opioids.
As part of an analysis of the impact of multimodal pain management (i.e. multiple drug classes or procedures to treat post-operative pain) and opioid usage, we conducted this study to considered how trends have changed over the last 10 years. Our data shows that opioid use for post-operative pain has declined substantially in patients undergoing total hip and knee arthroplasty (THA & TKA), two very common and often painful orthopedic procedures. Patients being treated with opioids alone for THA decreased from 47.6% in 2006 to 7.5% in 2016, with similar trends being seen in TKA patients.
Importantly, our data also showed that patients are increasingly being treated with a multimodal approach to pain control; especially patients being treated with 3 or more different pain modalities increased sharply in the last 10 years for both procedures in our study. This allows patients the benefit of managing their pain without many of the side-effect associated with large doses of a single pain medication. This trend was found to be especially true in small and medium sized hospitals, compared to larger hospitals. With increasing emphasis on limiting opioid use, this data shows us that the medical community is actively pursuing alternate possibilities for successfully treating post-operative pain.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Our analysis was able to show that the medical community is actively pushing against unnecessary opioid use in surgical patients and is embracing multimodal pain management as an effective approach in dealing with post-operative pain. Importantly, this shows that we are able to successfully treat pain with medications other than large-dose opioids. Trends over the last 10 years show a reduction in the percentage of patients receiving opioids alone, as well as the average amount of opioids used to control post-operative pain, while the amount of patients receiving multimodal pain management has increased sharply.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: For our group, and for medical professionals in general, it would be very interesting to see how trends have changed in out-of-hospital opioid prescribing after discharge. While our dataset allows us to analyze opioid and multimodal pain usage while patients are in the hospital, the amount and type of painkillers they are sent home with is an equally important part of the puzzle. This analysis was not possible with the dataset we had access to. Being able to show reduction in opioid use for post-operative pain both in-hospital and after discharge would signal a very large step in the right direction.
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Abstract presented at the Anesthesiology 2017, held October 21-25 in Boston, Massachusetts.
|Multimodal Pain Management in Total Hip and Knee Arthroplasty: Trends Over the Last 10 Years|
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