Overuse of the psychoactive analgesics’ opioids and gabapentinoid drugs in patients having surgery for nerve entrapment disorders

Abstract

Knowledge about risks for overuse of psychoactive analgesics in patients having primary surgery for carpal tunnel syndrome (CTS) or ulnar nerve entrapment (UNE), or both, is limited. We investigated if patients with those nerve entrapment disorders have a higher risk of overuse of psychoactive analgesics (i.e., opioids and gabapentinoid drugs) before, after, and both before and after surgery than observed in the general population after accounting for demographical and socioeconomic factors. Using a large record linkage database, we analysed 5,966,444 individuals (25–80 years), residing in Sweden December 31st, 2010–2014, of which 31,380 underwent surgery 2011–2013 for CTS, UNE, or both, applying logistic regression to estimate relative risk (RR) and 95% confidence interval (CI). Overall, overuse of the psychoactive analgesics was low in the general population. Compared to those individuals, unadjusted RR (95% CI) of overuse ranged in patients between 2.77 (2.57–3.00) with CTS after surgery and 6.21 (4.27–9.02) with both UNE and CTS after surgery. These risks were only slightly reduced after adjustment for demographical and socioeconomic factors. Patients undergoing surgery for CTS, UNE, or both, have a high risk of overuse of psychoactive analgesics before, after, and both before and after surgery.

Carpal Tunnel Syndrome and Trigger Finger May Be an Early Symptom of Preclinic Type 2 Diabetes

“…Finally, we categorized this cumulative income by tertiles into low, middle, or high (reference) income, as previously described in several articles. 8,9 Individuals with missing values on income during 2000 or 2005 were assigned the values for the year 2010. No individuals had missing income data for 2010.…”

“…Finally, we categorized this cumulative income by tertiles into low, middle, or high (reference) income, as previously described in several articles. 8,9 Individuals with missing values on Takeaways Question: Type 2 diabetes (T2D) is a major risk factor for carpal tunnel syndrome (CTS) and trigger finger (TF), but less is known regarding the risk of developing T2D after being diagnosed with CTS or TF.…”

The Unpredictable Ulnar Nerve—Ulnar Nerve Entrapment from Anatomical, Pathophysiological, and Biopsychosocial Aspects

“…A variety of systemic pharmacological substances have been suggested as a tool to treat the pain, including paracetamol, in combination with a selective COX-2 inhibitor, opioids, gabapentin, pregabalin, duloxetine, venlafaxine, and amitriptyline [ 65 , 67 , 85 ]. However, opioids are not recommended due to the risk of overuse, and overuse of opioids and gabapentinoid drugs, as reported after surgery for ulnar nerve entrapment alone, or in combination with carpal tunnel syndrome, is also higher than for carpal tunnel syndrome alone [ 86 ]. Locally, lidocaine-medicated patches, through their action of blockade of voltage-gated sodium channels and stabilization of the neuronal membranes as well as inhibition of ectopic discharge, are applicable to treat peripheral pain, e.g., around a surgical scar around the elbow [ 65 ].…”

Perceived stress, coping strategies, symptoms severity and function status among carpal tunnel syndrome patients: a nurse-led correlational Study

“…In this essence, perceived stress and coping mechanisms among patients with CTS received little consideration in contemporary literature; however, recent scholars argued that stress perception and the ways the patient with CTS uses to cope with stress and disability could worsen or improve both the symptoms of CTS and functional status [ 20 , 21 ]. Although the relationship between perceived stress, coping mechanisms, symptoms severity, and functional status among patients with CTS seems original at first glance, the exact role of perceived stress and coping toward symptoms severity and functional status among those patients has not been adequately explained in the literature.…”