No Association Between Postop Opioid Intake and Patient Satisfaction After Ankle Fracture

Researchers in this study found no association between opioid intake and patient satisfaction with treatment or with pain management after surgical management of ankle fractures, according to recent research published in the Journal of the American Academy of Orthopaedic Surgeons.

“Our study found disability and satisfaction to be related to ineffective coping strategies in response to nociception,” David Ring, MD, PhD, from the Department of Surgery and Perioperative Care at the University of Texas at Austin Dell Medical School, and colleagues wrote in their study. “Opioids should relieve pain, but greater opioid consumption was associated with greater pain.”

Dr Ring and colleagues enrolled 102 patients who underwent surgical treatment of ankle fractures, with 59 of those patients available for follow-up 5 to 8 months after removal of sutures. The researchers recorded trauma-related factors, opioid use, and disability, pain, and treatment satisfaction scores at baseline as well as at 5- and 8-month follow-up, with patients completing satisfaction scores at each follow-up period.

At baseline, there was no association between opioid intake and disability, as well as no association between opioid intake and pain management or treatment satisfaction, with no variables associated with opioid intake at 5- and 8-month follow-up. However, catastrophic thinking and pain anxiety were associated with factors such as satisfaction with pain management and with treatment, disability, pain at rest, and pain with activity at both the 5- and 8-month follow-up.

“Patients who understand the link between greater pain and greater symptoms of depression or a tendency to engage in catastrophic thinking (as opposed to confidence that one can adapt to a situation and achieve one’s goals, ie, self-efficacy) may be open to support. Experts in the function of the human mind (ie, psychologists, psychiatrists, social workers) can help people learn to improve their mood and increase their self-efficacy (eg, by means of cognitive behavioral therapy and its derivatives),” Dr Ring and colleagues wrote. “Patients who lack this type of insight can be supported empathetically while limiting unnecessary tests and treatments and using time as a therapeutic strategy in many instances.”

Summary and Clinical Applicability

The researchers concluded that patients may be able to take fewer opioids after surgical treatment of ankle fractures if there is no link between treatment and pain management satisfaction.

“In some studies, opioid use is associated with an increase in disability and decreased patient satisfaction,” Dr Ring and colleagues wrote. “In our opinion, to improve pain relief, surgeons should proactively address stress, distress, and ineffective coping strategies. Additional studies should examine how best to address stress and improve coping mechanisms, such as through coaching based on cognitive behavioral therapy.”

Limitations

The researchers noted recall bias for medication and dosage, that disability score was calculated at suture removal, that only 60% of patients were available for follow-up at 5 to 8 months after suture removal, and lack of analysis for improvements in depression symptoms and thinking in recovery as limitation in this study.

Disclosures

Finger or an immediate family member has stock options for Merck. Hageman or an immediate family member stock options for the PATIENT1 Foundation and received research from the Anna Foundation. Dr Ring or an immediate family member received royalties from Skeletal Dynamics and Wright Medical Group and is an advisory board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons and the Orthopaedic Trauma Association.

Reference

Finger A, Teunis T, Hageman MG, et al. Association between opioid intake and disability after surgical management of ankle fractures. J Am Acad Orthop Surg.  2017;25:519-526. doi: 10.5435/JAAOS-D-16-00505