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Opioids in Arthroplasty

Mind the Gap Between North America and the Rest of the World

Agrawal, Yuvraj, MD, FRCS(Tr&Orth)1,2; Smith, R. Malcolm, MD3; Garbuz, Donald S., MD, MHSc, FRCSC2; Masri, Bassam A., MD, FRCSC2

doi: 10.2106/JBJS.17.01422
Current Concepts Review
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Disclosures

  • ➤ 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.

1Department of Orthopaedics, Northern General Hospital, Sheffield, United Kingdom

2Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada

3Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts

E-mail address for B.A. Masri: bas.masri@vch.ca

Copyright © 2018 by The Journal of Bone and Joint Surgery, Incorporated
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