D. Rhon1, C. Cook2, J. Cleland3, S. Snodgrass4
1Brooke Army Medical Center, Department of Rehab Medicine, San Antonio, United States, 2Duke University, Department of Orthopaedics, Durham, United States, 3Tufts University School of Medicine, Department of Physical Therapy, Boston, United States, 4University of Newcastle, School of Health Sciences, Callaghan, Australia
Background: The adverse secondary health effects associated with opioid utilization may be a key reason for why opioid utilization also influences outcomes for patients with musculoskeletal pain. Prior opioid use is a predictor of poor outcomes, greater morbidity, higher complications rates, and higher downstream healthcare utilization as compared to individuals who have not used opioids. Opioid utilization for the treatment of musculoskeletal pain may place individuals at higher risk for poor outcomes if a surgery ever becomes necessary in the future. One limitation to the current body of literature is that the majority of studies reporting on the adverse health effects associated with prior opioid use have been conducted on surgical cohorts, as opioids are common after surgery and are often the initial exposure for many patients. Less is known about prior opioid use as a risk factor for poor outcomes within non-surgical patients with musculoskeletal pain.
Purpose: The purpose of this study was to compare downstream medical utilization-based outcomes (costs, visits, recurrent episodes) after an initial diagnosis of patellofemoral pain based on pre-injury utilization of opioids.
Methods: 85,7880 consecutive patients were followed for a full 12 months before and 24 months after an initial diagnosis of patellofemoral pain (January 2009 to December 2013). Data were sourced from the Military Health System Data Repository, a single-payer closed government system. Opioid prescription fills were identified, and medical visits and costs were calculated for all knee-related medical care, to include recurrence rates in the 2-year surveillance period.
Results: A relatively small number of individuals filled an opioid prescription in the year prior (n=1746; 2.0%); however, these individuals had almost twice the mean costs of knee-related medical care ($1557 versus %802) and medical visits (8.4 versus 4.0). Patients with prior opioid use were more likely to have at least 1 recurrent episode of knee pain (relative risk 1.58, 95% CI 1.51, 1.65) with a higher mean number of episodes of knee pain (1.5 vs 1.8). The use of opioids with higher risk of misuse or dependency (Schedule II or III) resulted in greater medical costs (for any reason) and recurrent episodes of knee pain compared to the use of opioids in a lower risk category (Schedule IV).
Conclusion(s): Prior opioid utilization was associated with a greater number of recurrent episodes of knee pain and higher downstream medical costs compared to individuals without prior opioid use. For individuals with prior opioid utilization, opioids with higher risk of misuse or dependency (Schedule II or III) resulted in greater medical costs (for any reason) and recurrent episodes compared to the use of lower-risk opioids (Schedule IV).
Implications: These results provide an additional perspective and potential added value in exploring opioid use history upon initial consultation for PFP. Clinicians should consider the risk for poor long-term outcomes, and be especially perceptive to other issues that combined with opioid use could contribute to poor outcomes.
Funding, acknowledgements: No funding
Keywords: patellofemoral pain, opioids, healthcare utilization
Topic: Pain & pain management
Did this work require ethics approval? Yes
Institution: Brooke Army Medical Center
Committee: Central Regional Health Command IRB
Ethics number: C.2016.048n
All authors, affiliations and abstracts have been published as submitted.
