Opioids in Arthroplasty

➤ From 1999 to 2016, >200,000 people died in the U.S. from overdoses related to prescription opioids. ➤ Pain is a cognitive, emotional, and behavioral response to nociception. Maladaptive behaviors, such as pain catastrophizing, interfere with the patient’s ability to cope with pain. ➤ Less adaptive coping strategies such as catastrophic thinking lead to greater pain intensity for a given nociception. ➤ Preoperative or postoperative opioid use for a prolonged period is associated with a higher risk of dependency and death. ➤ Prolonged use of opioid medication in the perioperative period is also associated with revision surgery in arthroplasty. ➤ Family physicians and orthopaedic surgeons are urged to review their prescription practices; to develop guidelines for responsible prescription management, with upper limits set on opioids; and to have a clearly understood and agreed-on pain management program for each patient.