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Orthopedic Surgeons Are Major Contributors to Opioid Epidemic, Study Finds

Opioid use can have detrimental effects on clinical outcomes

A new study has reported that orthopedic surgeons are prescribing opioids at an alarming rate, according to an online article in Forbes magazine. The study, which looked at the country’s opioid epidemic and its effect on orthopedic care in 2009, revealed that orthopedic surgeons are the third-highest prescribers of opioid prescriptions among U.S. physicians (7.7%), after primary care physicians (28.8%) and internists (14.6%).

The study was published in the May 2015 issue of the Journal of the American Academy of Orthopaedic Surgeons.

Co-author Dr. Brent J. Morris, a shoulder and elbow surgeon, said in an interview that there are several reasons why orthopedic surgeons prescribe opioid pain medications to patients. “Orthopedic injuries, including broken bones, can be very painful and may require casting or surgery to treat, and these are often treated with an opioid pain medication during the initial recovery period,” he said. “It is also very reasonable to use a short course of opioid pain medications to help with the recovery following surgery.”

Prescribing opioids, however, isn’t always the best option for a patient, the Forbes article says.

“It is important for physicians to reassure patients that they intend to control their pain but emphasize the importance of doing so in a responsible manner,” Morris said. “Part of this responsibility involves minimizing the use of opioids whenever possible. Good communication between providers and patients is the key in setting expectations regarding pain control and the role for non-opioid treatments.”

Nonopioid alternatives for managing a patient’s pain include over-the-counter medications, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). Another alternative to treating and managing orthopedic pain is nerve blocks, which are typically used in conjunction with surgery to limit additional pain after the procedure.

Study co-author Dr. Hassan R. Mir, associate professor of orthopedics and rehabilitation at Vanderbilt Orthopaedic Institute, said patients may face adverse effects from continued opioid use. “Management of pain is an important part of patient care; however, the increased usage of opioids for the treatment of pain has led to several unanticipated aftereffects for individual patients and for society at large,” he observed.

“Furthermore, pain control is an important determinant of patient satisfaction,” Mir added. “Physicians should aim to control pain and improve patient satisfaction while avoiding overprescribing opioids. Most patients truthfully represent their levels of pain, but unfortunately, a small percentage of patients use opioids nontherapeutically and ‘doctor shop’ for additional opioids, making this a delicate balancing act for orthopedic surgeons.”

Almost every state in the U.S. has implemented a prescription-monitoring program to assist physicians with tracking prescriptions for controlled substances. These policies can assist physicians with decreasing opioid prescriptions for musculoskeletal pain. Several other areas for potential research include alternative multimodal pain-control regimens, clinician and patient education, electronic health record utilization, and clinical practice guidelines.

“It is important for orthopedic surgeons and patients to understand the detrimental effects of opioid use on clinical outcomes across the spectrum of orthopedic subspecialties,” Mir said. “Opioid use has been associated with worse outcomes after work injuries, total knee arthroplasty, reverse shoulder arthroplasty, and spine surgery.”

Sources: Forbes; May 12, 2015; and JAAOS; May 2015.

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