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Risk Factors for Continued Opioid Use One to Two Months After Surgery for Musculoskeletal Trauma

Helmerhorst, Gijs T.T. MD; Vranceanu, Ana-Maria PhD; Vrahas, Mark MD; Smith, Malcolm MD; Ring, David MD, PhD

Journal of Bone & Joint Surgery - American Volume: 19 March 2014 - Volume 96 - Issue 6 - p 495–499
doi: 10.2106/JBJS.L.01406
Scientific Articles
Supplementary Content

Background: The aim of this study was to determine factors associated with self-reported ongoing use of opioid medication one to two months after operative treatment of musculoskeletal trauma.

Methods: Operatively treated patients (n = 145) with musculoskeletal trauma were evaluated one to two months after surgery. Patients indicated if they were taking opioid pain medication and completed several psychological questionnaires: the Center for Epidemiologic Studies Depression Scale, the Pain Catastrophizing Scale, the Pain Anxiety Symptoms Scale, and the Posttraumatic Stress Disorder Checklist, civilian version. The Numeric Rating Scale was used to measure pain intensity. Disability was measured with use of the Short Musculoskeletal Function Assessment Questionnaire and injury severity was measured with use of the Abbreviated Injury Scale.

Results: Patients who scored higher on the catastrophic thinking, anxiety, posttraumatic stress disorder, and depression questionnaires were significantly more likely (p < 0.001) to report taking opioid pain medications one to two months after surgery, regardless of injury severity, fracture site, or treating surgeon. The magnitude of disability as measured by the Short Musculoskeletal Function Assessment score was significantly higher (p < 0.001) in the patients who reported using opioids (40 points) compared with those who reported not using opioids (24 points). A logistic regression model not including pain intensity found that the single best predictor of reported opioid use was catastrophic thinking (odds ratio, 1.12 [95% confidence interval, 1.07 to 1.18]), which explained 23% of the variance (p < 0.001).

Conclusions: Patients who continue to use opioid pain medication one to two months after surgery for musculoskeletal trauma have more psychological distress, less effective coping strategies, and greater symptoms and disability than patients who do not take opioids, irrespective of injury, surgical procedure, or surgeon.

Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

1Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. E-mail address for G.T.T. Helmerhorst: E-mail address for A.-M. Vranceanu: E-mail address for M. Vrahas: E-mail address for M. Smith: E-mail address for D. Ring:

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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