Greater Mental Health Burden is Associated With Poor Postoperative Pain Control and Increased Opioid Utilization Following Total Shoulder Arthroplasty
Background Prolonged opioid use is associated with higher complications and worse patient-reported outcomes following total shoulder arthroplasty (TSA). Identified risk factors for prolonged postoperative use are related to several medical comorbidities, gender, diagnoses of anxiety or depressive di...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2024-01-01
|
| Series: | Journal of Shoulder and Elbow Arthroplasty |
| Online Access: | https://doi.org/10.1177/24715492231223665 |
| _version_ | 1797364560448978944 |
|---|---|
| author | Alexander J. MacFarlane MD Benjamin Ritter BSc Joshua Uffer MD Lin Feng MA Alexa Streicher MPH Mohammad N. Haider MD, PhD Thomas R. Duquin MD |
| author_facet | Alexander J. MacFarlane MD Benjamin Ritter BSc Joshua Uffer MD Lin Feng MA Alexa Streicher MPH Mohammad N. Haider MD, PhD Thomas R. Duquin MD |
| author_sort | Alexander J. MacFarlane MD |
| collection | DOAJ |
| description | Background Prolonged opioid use is associated with higher complications and worse patient-reported outcomes following total shoulder arthroplasty (TSA). Identified risk factors for prolonged postoperative use are related to several medical comorbidities, gender, diagnoses of anxiety or depressive disorders, and preoperative opioid use. In this study, we hypothesized that patient-reported mental health characteristics can help to identify patients at risk of worse postoperative pain control, worse sleep, and higher opioid utilization following TSA. Methods Ninety-three consecutive patients were asked to fill out 2 mental health questionnaires prior to undergoing TSA. Following surgery, patients filled out a daily pain diary to track their daily pain, pain medication use, and quality and duration of their sleep for 30 days. Preoperative opioid use and postoperative refill were determined by the New York State Prescription Monitoring Program. Mixed-model linear regressions were conducted. Significance was defined as p < 0.05. Results Postoperative opioid refill was associated with female gender, preoperative opioid therapy, higher inpatient opioid use, worse anxiety, depression, somatization, and pain catastrophizing scores. The number of days using opioids postoperatively was associated with worse pain catastrophizing scale (PCS) and somatization scores (patient health questionnaire-15). Preoperative opioid therapy was associated with worse somatization scores, whereas no opioids used after surgery were associated with better somatization scores. Worse sleep quality and duration were associated with worse PCS scores. Conclusion A greater mental health burden is associated with worse postoperative pain control and higher opioid utilization during the acute postoperative period. This is especially evident in the pain catastrophizing and somatization domains. |
| first_indexed | 2024-03-08T16:37:01Z |
| format | Article |
| id | doaj.art-30ec7a73c20043bb8d5a9c2559aa4866 |
| institution | Directory Open Access Journal |
| issn | 2471-5492 |
| language | English |
| last_indexed | 2024-03-08T16:37:01Z |
| publishDate | 2024-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Shoulder and Elbow Arthroplasty |
| spelling | doaj.art-30ec7a73c20043bb8d5a9c2559aa48662024-01-05T14:03:19ZengSAGE PublishingJournal of Shoulder and Elbow Arthroplasty2471-54922024-01-01810.1177/24715492231223665Greater Mental Health Burden is Associated With Poor Postoperative Pain Control and Increased Opioid Utilization Following Total Shoulder ArthroplastyAlexander J. MacFarlane MD0Benjamin Ritter BSc1Joshua Uffer MD2Lin Feng MA3Alexa Streicher MPH4Mohammad N. Haider MD, PhD5Thomas R. Duquin MD6 UBMD Orthopaedics and Sports Medicine, Buffalo, New York Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York UBMD Orthopaedics and Sports Medicine, Buffalo, New York UBMD Orthopaedics and Sports Medicine, Buffalo, New York UBMD Orthopaedics and Sports Medicine, Buffalo, New York UBMD Orthopaedics and Sports Medicine, Buffalo, New YorkBackground Prolonged opioid use is associated with higher complications and worse patient-reported outcomes following total shoulder arthroplasty (TSA). Identified risk factors for prolonged postoperative use are related to several medical comorbidities, gender, diagnoses of anxiety or depressive disorders, and preoperative opioid use. In this study, we hypothesized that patient-reported mental health characteristics can help to identify patients at risk of worse postoperative pain control, worse sleep, and higher opioid utilization following TSA. Methods Ninety-three consecutive patients were asked to fill out 2 mental health questionnaires prior to undergoing TSA. Following surgery, patients filled out a daily pain diary to track their daily pain, pain medication use, and quality and duration of their sleep for 30 days. Preoperative opioid use and postoperative refill were determined by the New York State Prescription Monitoring Program. Mixed-model linear regressions were conducted. Significance was defined as p < 0.05. Results Postoperative opioid refill was associated with female gender, preoperative opioid therapy, higher inpatient opioid use, worse anxiety, depression, somatization, and pain catastrophizing scores. The number of days using opioids postoperatively was associated with worse pain catastrophizing scale (PCS) and somatization scores (patient health questionnaire-15). Preoperative opioid therapy was associated with worse somatization scores, whereas no opioids used after surgery were associated with better somatization scores. Worse sleep quality and duration were associated with worse PCS scores. Conclusion A greater mental health burden is associated with worse postoperative pain control and higher opioid utilization during the acute postoperative period. This is especially evident in the pain catastrophizing and somatization domains.https://doi.org/10.1177/24715492231223665 |
| spellingShingle | Alexander J. MacFarlane MD Benjamin Ritter BSc Joshua Uffer MD Lin Feng MA Alexa Streicher MPH Mohammad N. Haider MD, PhD Thomas R. Duquin MD Greater Mental Health Burden is Associated With Poor Postoperative Pain Control and Increased Opioid Utilization Following Total Shoulder Arthroplasty Journal of Shoulder and Elbow Arthroplasty |
| title | Greater Mental Health Burden is Associated With Poor Postoperative Pain Control and Increased Opioid Utilization Following Total Shoulder Arthroplasty |
| title_full | Greater Mental Health Burden is Associated With Poor Postoperative Pain Control and Increased Opioid Utilization Following Total Shoulder Arthroplasty |
| title_fullStr | Greater Mental Health Burden is Associated With Poor Postoperative Pain Control and Increased Opioid Utilization Following Total Shoulder Arthroplasty |
| title_full_unstemmed | Greater Mental Health Burden is Associated With Poor Postoperative Pain Control and Increased Opioid Utilization Following Total Shoulder Arthroplasty |
| title_short | Greater Mental Health Burden is Associated With Poor Postoperative Pain Control and Increased Opioid Utilization Following Total Shoulder Arthroplasty |
| title_sort | greater mental health burden is associated with poor postoperative pain control and increased opioid utilization following total shoulder arthroplasty |
| url | https://doi.org/10.1177/24715492231223665 |
| work_keys_str_mv | AT alexanderjmacfarlanemd greatermentalhealthburdenisassociatedwithpoorpostoperativepaincontrolandincreasedopioidutilizationfollowingtotalshoulderarthroplasty AT benjaminritterbsc greatermentalhealthburdenisassociatedwithpoorpostoperativepaincontrolandincreasedopioidutilizationfollowingtotalshoulderarthroplasty AT joshuauffermd greatermentalhealthburdenisassociatedwithpoorpostoperativepaincontrolandincreasedopioidutilizationfollowingtotalshoulderarthroplasty AT linfengma greatermentalhealthburdenisassociatedwithpoorpostoperativepaincontrolandincreasedopioidutilizationfollowingtotalshoulderarthroplasty AT alexastreichermph greatermentalhealthburdenisassociatedwithpoorpostoperativepaincontrolandincreasedopioidutilizationfollowingtotalshoulderarthroplasty AT mohammadnhaidermdphd greatermentalhealthburdenisassociatedwithpoorpostoperativepaincontrolandincreasedopioidutilizationfollowingtotalshoulderarthroplasty AT thomasrduquinmd greatermentalhealthburdenisassociatedwithpoorpostoperativepaincontrolandincreasedopioidutilizationfollowingtotalshoulderarthroplasty |