Researchers at Hospital for Special Surgery (HSS) have identified gaps in patient knowledge about pain management and opioid use before total hip replacement, including misconceptions about how much pain relief to expect from opioids after surgery, how to use multiple modes of pain relief (multimodal analgesia) safely and effectively, and proper opioid storage and disposal. These findings were presented at the 2021 Spring American Society of Regional Anesthesia and Pain Medicine (ASRA) Annual Meeting.1
"Patients who are not taught about opioids and pain management may have difficulty with pain control and worse functional outcomes after total joint replacement," explained principal investigator Bradley Lee, MD, an anesthesiologist at HSS.
While research has shown benefits to educating patients about opioids, little is known about what patients understand about pain management prior to surgery.
Dr. Lee and colleagues interviewed patients via a 15-minute phone call to learn about their perceptions of pain management and opioid use. Eligible patients included those between ages 18 and 80 undergoing total hip replacement who are English-speaking with a reading comprehension above the eighth grade level. Survey questions were written by Dr. Lee in collaboration with members of the HSS Controlled Substances Task Force, an interdisciplinary committee focused on evidence-based opioid prescribing. Patients were instructed to answer the questions to the best of their ability, and if unsure to respond "I don't know."
Responses to the interviews revealed that while many patients acknowledge experiencing some pain after surgery is normal and that opioids should be used to reduce pain that limits function, many also believed that the goal of opioid use should be to experience minimal or no pain after surgery, reflecting somewhat inconsistent expectations.
Many patients were aware of the potential risk of addiction from opioid use. However, many did not understand the role of multimodal analgesia--that multiple forms of pain relief should be used in combination to better relieve pain, and that use of non-steroidal anti-inflammatory drugs (NSAIDs) can improve pain after surgery and reduce opioid use.
There were also gaps in patient understanding of opioid use and disposal. While many recognized the importance of keeping opioids away from children, only 15% recognized the importance of locking up these medications. The researchers also found that about half of patients were unsure of how to properly dispose of opioids.
These results show potential areas of patient education that could improve patient expectations and satisfaction, pain relief, and safety. "Patients may benefit from clinicians providing a consistent message on pain expectations and the goal of using opioids after surgery to treat pain. Patients may also benefit from education about the role of multimodal analgesia, as well as proper methods of storage and disposal," Dr. Lee noted.
"Future research should focus on educational interventions that address gaps in patients' understanding of opioids and pain management. Research should seek to identify which interventions are effective and how they affect outcomes," he concluded.
1. Bradley H. Lee, MD, Ryan Goydos, MS, Ejiro Gbaje, MPH, Alexandra Sideris, PhD, Christopher L. Wu, MD. "Evaluating Patient Perceptions of Pain Management and Opioid Use Prior to Hip Arthroplasty." Presented at: 46th Annual Regional Anesthesiology and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine (ASRA), May 13-15, 2021; Orlando, FL.
HSS is the world's leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 11th consecutive year), No. 4 in rheumatology by U.S. News & World Report (2020-2021), and named a leader in pediatric orthopedics by U.S. News & World Report "Best Children's Hospitals" list (2020-2021). HSS is ranked world #1 in orthopedics by Newsweek (2020-2021). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 130 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. http://www.