Long-term opioid use after discharge from inpatient musculoskeletal rehabilitation

Abstract

Objective: To determine: (i) the prevalence of opioid-naïve patients discharged on opioids from a musculoskeletal rehabilitation inpatient unit; (ii) the prevalence of opioid use 6 months after discharge; and (iii) the efficacy of the Opioid Risk Tool in identifying long-term opioid use. Design: Prospective study. Participants: Sixty-four opioid-naïve patients who were exposed to opioids during admission and who were discharged on an opioid. Methods: Potentially eligible patients' charts were reviewed. Participants were interviewed during admission to obtain the opioid risk score and contacted 6 months after discharge via a semi-structured telephone interview. Results: Twenty-eight percent of opioid-naïve patients, who were discharged on opioids were still using opioids 6 months after discharge from rehabilitation. There was a trend for higher Opioid Risk Tool scores in those still using opioids than in individuals who were not using opioids at 6 months (p = 0.053). Conclusion:Patients who are prescribed opioids during a hospital admission should be screened for risk of opioid misuse. This data suggests that the Opioid Risk Tool could identify a patient's potential for becoming a long-term user of opioids.

Factors Influencing Long-Term Opioid Use Among Opioid Naive Patients: An Examination of Initial Prescription Characteristics and Pain Etiologies

“…Previous studies have found that opioid prescribing upon discharge from an inpatient admission is strongly associated with opioid use either 6 months or 1 year post discharge, even among opioid-naïve patients. 3,14 The data also show that for other conditions such as trauma, surgery, and dental procedures, long term opioid use is not common. According to the unadjusted Kaplan Meier estimates, on average, fewer than 6% of persons with these pain etiologies were on opioids one year later.…”

Tourniquetless Total Knee Arthroplasty With Modern Perioperative Protocols Decreases Pain and Opioid Consumption in Women

“…Reduced opioid use in the postoperative period is likely to reduce unwanted opioid-related side effects such as constipation, potential for immunosuppression, urinary retention, sedation, and the increased medication load required to reduce these side effects [31] and may lessen the likelihood of chronic opioid dependence. [32] In addition, undesirable consequences associated with tourniquet use including pain, parasthesias, muscle weakness and rare, but devastating vascular injury, would be eliminated.…”

Opioid use in Older Orthopedic Rehabilitation Inpatients: A Retrospective Study

“…While psychiatric comorbidity (23) and cognitive impairment (29,30) have previously been linked to opioid use, they were not found to be signi cant in our model of opioid use (Table 3). One potential explanation is that their impact may be mediated through pain reporting or experience; indeed, the regression model for day 3 pain revealed these factors to be independently associated.…”

“…Charlson Comorbidity Index (22); health conditions associated with likelihood of conversion to chronic opioid use (1,23); baseline functional status for basic activities of daily living; the original indication for surgical or non-surgical treatment; the referring hospital where care was provided; and length of stay (LOS) in the referring hospital prior to arrival at rehabilitation. The following measures were recorded on admission to rehabilitation: EGFR (by the CKD-EPI equation) (24); Functional Independence Measure (FIM), a measure of mobility and function widely used in the rehabilitation setting to document a patient's progress (psychometric properties have been described in detail by Cournan) (25); and highest pain score on day 3 at rehabilitation (shown to be a useful initial time point for predicting the effect of pain on rehabilitation outcomes) (26).…”