Background/Purpose: The use of prescription opioids has been under increasing scrutiny due to concerns about the potential for misuse, dependency and increased adverse events. The objectives of our study were to examine the rates of prescription opioid use among pre-surgical knee, hip and spine osteoarthritis (OA) patients as well as the association between use and a range of socio-demographic and health status characteristics.

Methods: Study participants were 1204 patients with knee (N=577), hip (N=459) and spine (N=168) OA scheduled for surgery at a tertiary care hospital in Toronto, Canada. In pre-surgery questionnaires, data were collected on current usage (never, sometimes, daily) of opioid pain medications, as well as other prescription (NSAIDs, anti-depressants, neuroleptics) and over-the-counter pain medications for arthritis/joint pain. Additional questionnaire variables included: socio-demographics (age, sex, education), body mass index, comorbidity, depressive symptoms (Hospital Anxiety and Depression Scale) and pain level (0-10 numeric rating scale for average pain in the past week). Rates of opioid use were calculated by sex, age (<65 and 65+) and surgical site. Multivariable logistic regression was used to examine the associations between current reported opioid use (outcome: sometimes/daily vs. never) and other study variables.

Results: Participants were of mean age 65.6 years; 55.5% were women. Overall, 15% of patients reported ‘sometimes’ using opioid and an additional 15% reported ‘daily’ use. Any reported use of opioid was highest among spine OA patients (40%) and similar among knee and hip patients (28% and 30%). Younger women (<65 years) reported the greatest use of opioid overall, and particularly among spine patients (61%). From multivariable logistic regression, greater likelihood of opioid use was significantly associated with spine OA (vs. knee OA; p=0.03), younger age (p=0.02), obesity (vs. underweight/normal; p<0.01), fibromyalgia (present vs. absent; p=0.02), greater depressive symptoms (p=0.01), greater pain (p<0.001) and current use of other prescription pain medication (p<0.001).

Conclusion: Nearly a third of pre-surgical knee, hip and spine OA patients reported using prescription opioid medication for their OA pain. The higher use among younger individuals and those with greater depressive symptoms may warrant attention given growing concerns around adverse outcomes related to opioid use. While increased use of opioids among those with higher levels of current pain may be expected, this additionally raises questions as to whether these individuals are deriving intended clinical benefits. Further, available research suggests that opioid use in the surgical OA population may negatively impact outcomes. Consideration of pre-surgical opioid use screening, including potential dependency, may be warranted for patients undergoing surgery for OA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-associated-with-opioid-use-in-end-stage-knee-hip-and-spine-osteoarthritis/