Self-Loathing Aspects of Depression Reduce Postoperative Opioid Cessation Rate

Abstract

Objective We previously reported that increased preoperative Beck Depression Inventory II (BDI-II) scores were associated with a 47% (95% CI 24%–64%) reduction in the rate of opioid cessation following surgery. (1) We aimed to identify the underlying factors of the BDI-II (affective/cognitive vs. somatic) associated with a decreased rate of opioid cessation after surgery. Methods We conducted a secondary analysis of the data from a previously reported (1) prospective, longitudinal, observational study of opioid use after 5 distinct surgical procedures (total hip replacement, total knee replacement, thoracotomy, mastectomy, and lumpectomy) in 107 patients. The primary endpoint was time to opioid cessation. After exploratory factor analysis of the BDI-II, mean summary scores were calculated for each identified factor. These scores were evaluated as predictors of time to opioid cessation using Cox proportional hazards regression. Results The exploratory factor analysis produced three factors (self-loathing symptoms, motivational symptoms, emotional symptoms). All three factors were significant predictors in univariate analysis. Of the three identified factors of the BDI-II, only preoperative self-loathing symptoms (past failure, guilty feelings, self-dislike, self-criticalness, suicidal thoughts, worthlessness) independently predicted a significant decrease in opioid cessation rate after surgery in the multivariate analysis (HR 0.86, 95% CI 0.75–0.99, p-value 0.037). Conclusions Our results identify a set of negative cognitions predicting prolonged time to postoperative opioid cessation. Somatic symptoms captured by the BDI-II were not primarily responsible for the association between preoperative BDI-II scores and postoperative prolonged opioid use.

A Feasibility Study of Percutaneous Peripheral Nerve Stimulation for the Treatment of Postoperative Pain Following Total Knee Arthroplasty

“…Previous studies on outcomes following TKA using traditional approaches to postoperative analgesia have reported extended opioid use and delayed functional recovery. In recent studies of patients receiving various postoperative treatments (e.g., oral medications, local anesthetic-based nerve blocks, transcutaneous electrical nerve stimulation, intravenous acetaminophen), average opioid consumption is often greatest during the immediate postoperative period (e.g., average daily morphine equivalent dosage [MED] of approximately 30-170 mg during postoperative days 0-3) (7,(39)(40)(41)(42)(43); fewer than 30% of patients had ceased opioid use by four weeks following TKA, and the median time to opioid cessation was approximately 45-60 days (4,6,7). In the present study, average daily MED during postoperative days 0-3 was approximately 22 mg, a majority (4 of 7; 57%) of subjects reported opioid cessation within the first week following surgery, and the median time to opioid cessation was six days.…”

“…Postoperative pain is most often treated with opioid analgesics, however, these have a high risk of misuse and debilitating side effects (e.g., sedation, dizziness, nausea, constipation, urinary retention, and sleeping problems) that often interfere with physical rehabilitation and function. Recent studies show that opioid use continues at least four weeks following TKA in over 70% of patients, with the median time to opioid cessation approximately 45–60 days .…”

Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic

“…69 In a mixed surgical cohort, elevated preoperative Beck Depression Inventory-II (BDI-II) scores were a significant predictor of prolonged opioid use independent of pain in a mixed surgical cohort 66 Further factor analysis identified self-loathing symptoms of the BDI-II as a significant predictor of prolonged opioid use rather than somatic symptoms, which could be confounded by pain and other medical comorbidities in a surgical cohort. 70–72 The primary determinants of postoperative opioid cessation appear unrelated to the duration of postoperative pain and preoperative pain intensity both at the future surgical site and elsewhere over the entire body. 66 Thus, specific efforts to promote opioid cessation are warranted aside from focusing solely on optimizing pain management in the postoperative period.…”

Pain Catastrophizing Moderates Relationships between Pain Intensity and Opioid Prescription

“…11 Post-surgically, opioid use is commonly quantified either by dose or by time to opioid cessation. 12,13 Perioperative studies have yielded mixed findings for pain catastrophizing, with some reporting a direct relationship with morphine dose delivered either by patient controlled analgesia devices 14 or by hospital staff, 15 while other studies reported no association 16 or an inverse association. 17 Findings from a recent longitudinal study of 145 musculoskeletal trauma surgery patients suggested that pain catastrophizing predicted delayed opioid cessation after surgery.…”