Background & Aims

Total Knee Arthroplasty (TKA) is consistently associated with high postoperative pain, putting patients at risk for delayed rehabilitation and recovery. Due to the current opioid epidemic, guidance on postoperative pain management includes (1) non-opioid analgesics and non-pharmacological therapies as first-line treatment and (2) short-acting opioids for severe pain ?14 days. Early reports suggested that patients look to other sources for pain relief, such as rogue Fentanyl powder and Gabapentin. Health care providers, therefore, are facing the challenge of simultaneously optimizing postoperative pain management while limiting opioid use postoperatively. In this poster, we will report pharmacological (including use of illicit medications) and non-pharmacological strategies used by Veterans to manage pain and the helpfulness of these strategies.

Methods

A cross-sectional, secondary analysis was conducted using data collected 3 months postoperatively from 309 Veterans enrolled in an on-going, double-blind, two-arm, randomized controlled trial, evaluating the efficacy of an Acceptance and Commitment Therapy (ACT) intervention in veterans at risk for PPSP following TKA. The Pain Management Strategies Survey (PMSS) was used to collect all pharmacological and non-pharmacological pain management strategies used from surgery to 3 months postoperatively. Descriptive statistics were used to describe the pharmacological and non-pharmacological pain management strategies used and their perceived helpfulness.

Results

Of the 309 Veterans surveyed, 288 reported using pharmacological strategies, the majority of which reported use of two or more strategies (n=267; 92.7%). Frequently used strategies included prescribed opioids (n=241; 83.7%), acetaminophen (n=234; 81.3%), and NSAIDS (n=188; 65.3%). Furthermore, 52 participants (18.1%) reported the use of illicit or unconventional medications, including CBD (n=36; 69.2%), cannabis (n=22; 42.3%), illicit opioids (n=6; 11.5%), and other illicit substances (n=1; 1.9%). Among these participants, 42 (88.8%) reported taking these medication(s) in addition to prescribed opioids, while 10 (19.2%) reported the use of these medications only. A similar number of participants (n=287) reported using at least one non-pharmacological strategy. The most frequently used strategies included physical therapy (n=281; 97.9%), heat or cold (n=232; 80.8%), and regular exercise (n=192; 66.9%). Additional strategies and their perceived helpfulness will be presented.

Conclusions

This study confirms that a subset of patients take illicit or unconventional medications to help manage their pain following TKA. While most of these patients used these medications in addition to opioids, further research is needed to determine if these medications were used at the same time or consecutively due to limited opioid prescriptions. This study also demonstrated that patients required opioids to manage their postoperative pain following TKA and that additional non-opioid medications and non-pharmacologic strategies were also frequently needed.

References

1.Ip HY, Abrishami A, Peng PW, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology. 2009;111(3):657-77.
2.Prescribing Opioids for Postoperative Pain – Supplemental Guidance. Dr. Robert Bree Collaborative (Bree Collaborative) and the Washington Agency Medical Directors’ Group (AMDG), 2018. Available at: https://www.qualityhealth.org/bree/wp-content/uploads/sites/8/2018/09/Final-Supplemental-Bree-AMDG-Postop-pain-091318-wcover.pdf
3.Buttram ME, Kurtz SP, Dart RC, Margolin ZR. Law enforcement-derived data on gabapentin diversion and misuse, 2002-2015: diversion rates and qualitative research findings. Pharmacoepidemiology and drug safety. 2017;26(9):1083-6.
4.Maxwell JC. Substance Abuse Trends in Texas 2017: A Report to the National Drug Early Warning System. 2017.
5.Marquez-Lara, A., Hutchinson, I. D., Nuñez, F., Smith, T. L. & Miller, A. N. Nonsteroidal Anti-Inflammatory Drugs and Bone-Healing: A Systematic Review of Research Quality. JBJS Rev. 4, e4 (2016).
6.Jette, D. U. et al. Physical Therapist Management of Total Knee Arthroplasty. Phys. Ther. 100, 1603–1631 (2020).

Presenting Author

Kyung Soo Kim

Poster Authors

Kyung Soo Kim

RN

University of Iowa

Lead Author

Jennie Embree

University of Iowa

Lead Author

M. Bridget Zimmerman

University of Iowa

Lead Author

Katherine Hadlandsmyth

University of Iowa

Lead Author

Tracey Smith

Baylor College of Medicine

Lead Author

Joseph Buckwalter

MD

University of Iowa

Lead Author

David Green

MD

Baylor College of Medicine

Lead Author

Lilian Dindo

Baylor College of Medicine

Lead Author

Barbara Rakel

University of Iowa

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Post-surgical/Post-traumatic Chronic Pain