Patient education and engagement in postoperative pain management decreases opioid use following knee replacement surgery

Yajnik, M.; Hill, Jonay N; Hunter, Oluwatobi O; Howard, Steven K.; Kim, T. Edward; Harrison, T. Kyle; Mariano, Edward R.

doi:10.1016/j.pec.2018.09.001

Cited by 69 publications

(63 citation statements)

References 21 publications

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“…In the most recent study by Riddle et al [ 63 ], patients receiving pain coping skills training did not have significantly better scores on WOMAC function and the short physical performance battery. Other types of education [ 42 , 44 , 48 – 50 , 55 ], music during physiotherapy [ 38 ], enhanced reality analgesia [ 69 ], cognitive behavioural therapy delivered by physiotherapists [ 56 ], and psychological support from a professional psychologist [ 23 ] did also not affect any of the functional outcome measures after TKA.…”

Section: Resultsmentioning

confidence: 99%

The influence of perioperative interventions targeting psychological distress on clinical outcome after total knee arthroplasty

et al. 2020

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Our aim was to assess the effect of perioperative interventions targeting psychological distress on clinical outcome after total knee arthroplasty (TKA). We searched studies on the effect of perioperative interventions focused on psychological distress used in conjunction with TKA on pain, function, and quality of life (QoL) on PubMed, Embase.com, PsycINFO/OVID, CENTRAL, the Cochrane Database of Systematic Reviews, Scopus, and Web of Science. We included 40 studies (22 RCTs, ten cohort studies, and eight quasi-experimental studies) with a total of 3846 patients. We graded the quality of evidence as low for pain and function and as moderate for QoL. Patients receiving music, education, cognitive behavioural therapy, guided imagery, pain coping skills training, Reiki, occupational therapy with self-monitoring, and biofeedback-assisted progressive muscles relaxing training had lower pain scores or declined opioid prescriptions after TKA. Pain coping skills training, audio recording-guided imagery scripts, video promoting self-confidence, psychological therapies by video, Reiki, music, occupational therapy with self-monitoring, education, and psychotherapy improved postoperative functional outcome. Education through an app improved QoL after TKA. The studies in our systematic review show that perioperative interventions targeting psychological distress for patients receiving TKA seem to have a positive effect on postoperative pain, function, and QoL. RCTs with strict methodological safeguards are still needed to determine if perioperative interventions focused on psychological distress should be used in conjunction with TKA. These studies should also assess which type of intervention will be most effective in improving patient-reported outcome measures and declining opioid prescriptions.

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Section: Resultsmentioning

confidence: 99%

The influence of perioperative interventions targeting psychological distress on clinical outcome after total knee arthroplasty

et al. 2020

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“…21,22 A relatively simple intervention of setting patients' expectations regarding pain after TKA, providing a more detailed pain scale, and educating patients regarding their postoperative pain medications has been shown to decrease the utilization of opioids after surgery. 23 In terms of pharmacology, paracetamol or acetaminophen acts centrally and should be given to all surgical patients unless contraindicated. Although its exact mechanisms of action are not completely understood, analgesia may result from activation of descending serotonergic (inhibitory) pain pathways, interfering with prostaglandin synthesis, and interacting with the endocannabinoid system.…”

Section: Processing Of Painmentioning

confidence: 99%

“…26 Today, the use of opioids for breakthrough pain relief post-TKA has not been eliminated for most patients in the United States even in the setting of robust multimodal analgesia and patient education. 23 However, the integration of non-pharmacologic interventions and non-opioid analgesic modalities including regional anesthesia techniques effectively decreases opioid consumption and should be considered routine. 4,11,23 In order to be successful, ERPs must be accepted by both healthcare practitioners and patients.…”

Section: Processing Of Painmentioning

confidence: 99%

“…23 However, the integration of non-pharmacologic interventions and non-opioid analgesic modalities including regional anesthesia techniques effectively decreases opioid consumption and should be considered routine. 4,11,23 In order to be successful, ERPs must be accepted by both healthcare practitioners and patients. Ethical concerns have been raised about the "weaponization" of ERPs with the goal of eliminating all postoperative opioids even in patients on long-term opioids.…”

Section: Processing Of Painmentioning

confidence: 99%

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<p>A Commonsense Patient-Centered Approach to Multimodal Analgesia Within Surgical Enhanced Recovery Protocols</p>

Mariano¹,

Schatman²

2019

JPR

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“…Numerous strategies have been used worldwide to try to reduce excessive or unnecessary opioid prescription post‐operatively. Patient and prescriber education, structured post‐operative protocols and regimented discharge planning have all been used with varying degrees of success. Use of alternative analgesia has also increased, including the use of multimodal analgesia (MMA), which has allowed synergistic use of different analgesics at lower overall doses …”

Section: Introductionmentioning

confidence: 99%

Opioid prescribing improvement in orthopaedic specialty unit in a tertiary hospital: a retrospective audit of hospital discharge data pre‐ and post‐intervention for better opioid prescribing practice

Stanley

Jackson

Norman

et al. 2019

ANZ Journal of Surgery

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Background: This study aimed to investigate the effects of an intervention focusing on better opioid prescription practice in a tertiary metropolitan hospital orthopaedic unit. Methods: Following a previous audit of opioid prescribing in the orthopaedics unit, an intervention comprising the (i) Expert Advisory Group oversight of opioid prescribing, (ii) development of a prescription opioid guideline for various hospital contexts and (iii) a series of education sessions was undertaken to improve opioid prescription practice. A reaudit was subsequently carried out to determine whether the intervention had had an impact on the previously audited orthopaedic unit. Results: Each audit period was 6 months. There were 281 orthopaedic patients in the original audit (). In both audits, a high proportion of patients were discharged to the community on opioids, 82.2% (n = 231) pre-intervention and 79.6% (n = 230) post-intervention. Statistically significant differences in opioid prescribing were found between audits, including: a reduction in the number of patients discharged on combination opioids from 71.4% to 45.7% (P < 0.001), a reduction in the provision of full pharmaceutical quantities of opioid on discharge from 29.4% to 6.1% (P < 0.001) and an increase in opioid weaning plans included in discharge summaries from 6.9% to 87.4% (P < 0.001). Conclusion: Raised awareness across the organization and education for staff more than halved the post-operative opioid prescription levels. This highlights the capacity for change in hospitals and the ability to work towards safer prescribing of post-operative opioid therapy.

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Patient education and engagement in postoperative pain management decreases opioid use following knee replacement surgery

Cited by 69 publications

References 21 publications

The influence of perioperative interventions targeting psychological distress on clinical outcome after total knee arthroplasty

The influence of perioperative interventions targeting psychological distress on clinical outcome after total knee arthroplasty

<p>A Commonsense Patient-Centered Approach to Multimodal Analgesia Within Surgical Enhanced Recovery Protocols</p>

Opioid prescribing improvement in orthopaedic specialty unit in a tertiary hospital: a retrospective audit of hospital discharge data pre‐ and post‐intervention for better opioid prescribing practice

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