Paper cautions against increased opioid use in orthopaedics
By Canadian Chiropractor staffFeatures Clinical Patient Care
A new paper published in the Journal of the American Academy of Orthopaedic Surgeons has urged orthopedic surgeons to help combat the increasing “opioid epidemic” that is transpiring in the U.S.
In the paper titled, The Opioid Epidemic: Impact on Orthopaedic Surgery, authors Dr. Brent Morris and Dr. Hassan Mir, both medical doctors, noted orthopaedic surgeons are the third highest prescribers of opioid in the U.S., accounting for 7.7 per cent of all opioid prescriptions in 2009.
“Nontherapeutic opioid use is becoming more prevalent across multiple specialties, including orthopaedics, and carries a risk of potentially serious consequences,” the paper stated. “Orthopaedic surgeons must continue to treat their patients’ pain while also establishing strategies based on objective measures and patient communication to help battle the opioid epidemic at both the individual and societal levels.”
The paper cited a recent study, which highlighted the difference in opioid use between the U.S. and the Netherlands. The study involved patients with hip and ankle fractures. Eighty-five per cent of the patients with hip fractures in the U.S. were prescribed opioids after discharge, while none of the Dutch patients were given opioid prescriptions. U.S. doctors also prescribed opioid to 82 per cent of the patients with ankle fractures, while only six per cent of the patients were prescribed in the Netherlands. The Dutch patients were instead prescribed nonopioid analgesics, including acetaminophen and NSAIDS.
The paper it is important for both orthopaedic surgeons and patients to understand the detrimental effects of opioid use. “For example, opioid use has been associated with worse clinical outcomes in musculoskeletal disorders, total knee arthroplasty, reverse shoulder arthroplasty and spine surgery.”
The American Chiropractic Association (ACA) echoed the call for caution in opioid prescription. In a release, the ACA urged patients and health-care providers to consider first exhausting conservative forms of pain management.
“Beyond the risks of overuse and addiction, prescription drugs that numb pain may convince a patient that a musculoskeletal condition is less severe than it is, or that it has healed. That misunderstanding can lead to overexertion and a delay in the healing process or even to permanent injury,” said ACA media spokesperson Robert Hayden.
According to Hayden, one potential strategy is the use of conservative forms of care for pain before initiating higher-risk options such as opioids. A conservative health care model emphasizes more cost-effective and safer approaches over potentially addictive medications or surgery for pain management and health enhancement.
“For example, conservative management of back pain may include trying spinal manipulation combined with exercise and stretching prior to moving on to procedures involving higher risk,” the ACA release said.
Health care quality organizations now recognize the value of a conservative approach. Earlier this year, the Joint Commission, which certifies more than 20,000 health-care organizations and programs in the United States, including every major hospital, revised its pain management standard to include chiropractic services and acupuncture. Clinical experts in pain management who provide input to the Commission’s standards affirmed that treatment strategies may consider both pharmacologic and nonpharmacologic approaches.
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