Mental health disorders and pain modulation in orthopedic shoulder patients
Background: Various studies have examined the relationship between preoperative mental health diagnoses (MHDs) and postoperative outcomes in orthopedic shoulder patients. However, few investigations delve into the relationship between a preoperative MHD and postoperative opioid pain control regimens...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-11-01
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| Series: | JSES International |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666638323001597 |
| _version_ | 1827781652570439680 |
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| author | MaKenzie M. Chambers, BS Diego Martinez Castaneda, BS Christopher Rivera-Pintado, MD Pietro Gentile, BS Krystal Hunter, MBA, PhD Catherine J. Fedorka, MD |
| author_facet | MaKenzie M. Chambers, BS Diego Martinez Castaneda, BS Christopher Rivera-Pintado, MD Pietro Gentile, BS Krystal Hunter, MBA, PhD Catherine J. Fedorka, MD |
| author_sort | MaKenzie M. Chambers, BS |
| collection | DOAJ |
| description | Background: Various studies have examined the relationship between preoperative mental health diagnoses (MHDs) and postoperative outcomes in orthopedic shoulder patients. However, few investigations delve into the relationship between a preoperative MHD and postoperative opioid pain control regimens in patients who have undergone rotator cuff repair (RCR), total shoulder arthroplasty (TSA), and reverse TSA (rTSA). We hypothesize that orthopedic shoulder patients with a preoperative MHD will be prescribed more opioids (ie, request more refills) postoperatively than those without a MHD. Methods: An institutional review board-approved retrospective chart review was performed on 438 patients, 18 years or older, who underwent RCR, TSA, or rTSA. Patients were divided into two groups: those diagnosed with depression, anxiety, bipolar disorder, and/or schizophrenia (n = 193), and those with no previous MHD (n = 245). Statistical outcomes were analyzed with the independent t-test, Mann-Whitney U test, one-way Analysis of Variance, and Kruskal-Wallis test. Results: Univariate analysis demonstrated significant differences between the MHD group and non-MHD group in average 90-day postoperative opioid scripts (2.10 vs. 1.55, respectively, P < .001) and median 90-day postoperative morphine milligram equivalents (MMEs) prescribed (225 MME vs. 185.25 MME, respectively, P < .001). Among patients who were opioid naive 90 days preoperatively, significant differences were found in MMEs prescribed between the MHD and non-MHD group (225 MME vs. 150 MME, respectively, P < .001). Further analysis of opioid naive patients with specifically depression compared to patients with an alternate or no MHD diagnosis yielded significant differences in scripts (1.78 vs. 1.33, respectively, P = .031) and MMEs prescribed (225 MME vs. 150 MME, respectively, P < .001). Conclusion: This study found that RCR, TSA, or rTSA patients with a preoperative MHD were prescribed significantly more postoperative MMEs and more opioid scripts (ie, requested more refills) than those without MHD. This is despite preoperative education on postoperative pain expectations and limiting opioid use. Our findings support our hypothesis and emphasize the clinical importance of recognizing mental health disease while navigating postoperative pain control expectations. Given the rising prevalence of mental health disorders nationwide, considering the effect of these comorbidities on postoperative pain in RCR, TSA, and rTSA patients will be essential to enhance preoperative and postoperative counseling and management by orthopedic surgeons. We further recommend a multidisciplinary approach to help manage pain in these patients. |
| first_indexed | 2024-03-11T15:21:43Z |
| format | Article |
| id | doaj.art-12330c977e6b4b999e6aebec8db845ea |
| institution | Directory Open Access Journal |
| issn | 2666-6383 |
| language | English |
| last_indexed | 2024-03-11T15:21:43Z |
| publishDate | 2023-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JSES International |
| spelling | doaj.art-12330c977e6b4b999e6aebec8db845ea2023-10-28T05:09:47ZengElsevierJSES International2666-63832023-11-017625232527Mental health disorders and pain modulation in orthopedic shoulder patientsMaKenzie M. Chambers, BS0Diego Martinez Castaneda, BS1Christopher Rivera-Pintado, MD2Pietro Gentile, BS3Krystal Hunter, MBA, PhD4Catherine J. Fedorka, MD5Cooper Medical School of Rowan University, Camden, NJ, USACooper Medical School of Rowan University, Camden, NJ, USADepartment of Orthopedic Surgery, Cooper University Healthcare, Camden, NJ, USADepartment of Orthopedic Surgery, Cooper University Healthcare, Camden, NJ, USACooper Medical School of Rowan University, Camden, NJ, USA; Department of Orthopedic Surgery, Cooper University Healthcare, Camden, NJ, USACooper Medical School of Rowan University, Camden, NJ, USA; Department of Orthopedic Surgery, Cooper University Healthcare, Camden, NJ, USA; Corresponding author: Dr. Catherine J. Fedorka, MD, Cooper Bone and Joint Institute, 3 Cooper Plaza Suite 408, Camden, NJ 08103, USA.Background: Various studies have examined the relationship between preoperative mental health diagnoses (MHDs) and postoperative outcomes in orthopedic shoulder patients. However, few investigations delve into the relationship between a preoperative MHD and postoperative opioid pain control regimens in patients who have undergone rotator cuff repair (RCR), total shoulder arthroplasty (TSA), and reverse TSA (rTSA). We hypothesize that orthopedic shoulder patients with a preoperative MHD will be prescribed more opioids (ie, request more refills) postoperatively than those without a MHD. Methods: An institutional review board-approved retrospective chart review was performed on 438 patients, 18 years or older, who underwent RCR, TSA, or rTSA. Patients were divided into two groups: those diagnosed with depression, anxiety, bipolar disorder, and/or schizophrenia (n = 193), and those with no previous MHD (n = 245). Statistical outcomes were analyzed with the independent t-test, Mann-Whitney U test, one-way Analysis of Variance, and Kruskal-Wallis test. Results: Univariate analysis demonstrated significant differences between the MHD group and non-MHD group in average 90-day postoperative opioid scripts (2.10 vs. 1.55, respectively, P < .001) and median 90-day postoperative morphine milligram equivalents (MMEs) prescribed (225 MME vs. 185.25 MME, respectively, P < .001). Among patients who were opioid naive 90 days preoperatively, significant differences were found in MMEs prescribed between the MHD and non-MHD group (225 MME vs. 150 MME, respectively, P < .001). Further analysis of opioid naive patients with specifically depression compared to patients with an alternate or no MHD diagnosis yielded significant differences in scripts (1.78 vs. 1.33, respectively, P = .031) and MMEs prescribed (225 MME vs. 150 MME, respectively, P < .001). Conclusion: This study found that RCR, TSA, or rTSA patients with a preoperative MHD were prescribed significantly more postoperative MMEs and more opioid scripts (ie, requested more refills) than those without MHD. This is despite preoperative education on postoperative pain expectations and limiting opioid use. Our findings support our hypothesis and emphasize the clinical importance of recognizing mental health disease while navigating postoperative pain control expectations. Given the rising prevalence of mental health disorders nationwide, considering the effect of these comorbidities on postoperative pain in RCR, TSA, and rTSA patients will be essential to enhance preoperative and postoperative counseling and management by orthopedic surgeons. We further recommend a multidisciplinary approach to help manage pain in these patients.http://www.sciencedirect.com/science/article/pii/S2666638323001597Rotator cuff tearTotal shoulder arthroplastyReverse total shoulder arthroplastyMental healthOpioidPain management |
| spellingShingle | MaKenzie M. Chambers, BS Diego Martinez Castaneda, BS Christopher Rivera-Pintado, MD Pietro Gentile, BS Krystal Hunter, MBA, PhD Catherine J. Fedorka, MD Mental health disorders and pain modulation in orthopedic shoulder patients JSES International Rotator cuff tear Total shoulder arthroplasty Reverse total shoulder arthroplasty Mental health Opioid Pain management |
| title | Mental health disorders and pain modulation in orthopedic shoulder patients |
| title_full | Mental health disorders and pain modulation in orthopedic shoulder patients |
| title_fullStr | Mental health disorders and pain modulation in orthopedic shoulder patients |
| title_full_unstemmed | Mental health disorders and pain modulation in orthopedic shoulder patients |
| title_short | Mental health disorders and pain modulation in orthopedic shoulder patients |
| title_sort | mental health disorders and pain modulation in orthopedic shoulder patients |
| topic | Rotator cuff tear Total shoulder arthroplasty Reverse total shoulder arthroplasty Mental health Opioid Pain management |
| url | http://www.sciencedirect.com/science/article/pii/S2666638323001597 |
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