Use of Prescription Opioids to Manage Acute Pain after Orthopedic Surgery

For many people, their first exposure to opioids is when they receive an opioid prescription from their doctor to treat acute (short-term) pain following a surgical procedure. An estimated 67 million opioid prescriptions are written each year in the U.S. by surgically-focused specialties.¹

Although prescription opioids are effective at treating moderate to severe pain, they also come with a risk of addiction. One study found that 1 in 16 patients become long-term opioid users after surgery.² Even short-term opioid use can lead to misuse, addiction and, too often, overdose.

Opioid Overprescribing in Orthopedic Surgery

Amongst physicians, orthopedic surgeons are the third-highest prescribers of opioid medications, accounting for nearly 8% of all opioid prescriptions in the United States.³ Orthopedic surgeons specialize in preventing, diagnosing, and treating disorders of the bones, joints, ligaments, tendons, and muscles. They treat a range of conditions, both surgically and non-surgically, including sports injuries and joint replacements like knees and hips.

Each year, approximately 7 million orthopedic surgeries are performed in the United States.⁴ Safe and effective pain control after these surgeries is critical to restoring the patient’s mobility. However, research has shown that over-prescription of opioids to manage pain after an operation is common in orthopedic surgery.^5,6,7

Knee and hip replacements are two of the most common orthopedic surgeries performed annually. One study found that among patients who had never taken opioids prior to their surgery, 8.2% of patients who underwent a knee replacement and 4.3% of patients who underwent a hip replacement were still using opioids 6 months later.⁸

Know Your Risk for Opioid Use Disorder

Physicians have an ethical and professional obligation to manage their patients’ pain without putting them at increased risk for addiction. Because the risk of addiction is higher for some people than others, it’s important that you and your physician understand your personal risk for opioid addiction (also called Opioid Use Disorder, or OUD) before opioids are ever prescribed.

There are many known factors associated with increased risk for opioid addiction, including your genetics.⁹ The good news is that thanks to recent scientific advances, physicians and patients now have a way to assess genetic risk for OUD before a prescription is written.

Make More Informed Decisions About Pain Management

AvertD™ is a clinically validated test that identifies an individual’s genetic risk for developing OUD. The test requires only a simple cheek swab sample and analyzes 15 genetic markers involved in the brain reward pathways associated with addiction to identify if a patient may have an elevated genetic risk for OUD.

When use of prescription oral opioids for acute pain is being considered, AvertD offers an objective way to identify who may have an elevated genetic risk for opioid addiction—so you and your provider can make more informed decisions about how to manage your pain safely and effectively.

Are you having surgery soon? Will you be prescribed an opioid? Do you know your risk for developing OUD?

If you’re scheduled for a procedure where oral opioids may be prescribed to manage acute pain (pain expected to last <30 days), you should consider taking the AvertD test. Learn more at https://avertdtest.com/for-patients/

Note: Because genetics are only one factor in understanding the risk of developing OUD from using oral opioids, AvertD test results should always be used in conjunction with a complete clinical evaluation to determine the appropriateness of oral opioids for pain management.

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Additional Resources:

• To learn more about managing pain with medication after orthopedic surgery, visit: https://orthoinfo.org/en/recovery/managing-pain-with-medications/
• To view current treatment recommendations from the Centers for Disease Control and Prevention (CDC) for selected common acute pain conditions, visit https://www.cdc.gov/acute-pain/index.html

References:

¹Stark N, Kerr S, Stevens J. Prevalence and predictors of persistent post-surgical opioid use: a prospective observational cohort study. Anaesth Intensive Care. 2017;45(6):700-706. doi:10.1177/0310057X1704500609

²Brummett CM, Waljee JF, Goesling J, et al. New Persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg 2017;152:e170504

³Volkow N.D., McLellan T.A., Cotto J.H., Karithanom M., Weiss S.R.B. Characteristics of opioid prescriptions in 2009. JAMA. 2011;305:1299–1301. doi: 10.1001/jama.2011.401

⁴Orthopedic Design and Technology. U.S. Healthcare Spending in Orthopedics. https://www.odtmag.com/issues/2019-05-24/view_columns/us-healthcare-spending-in-orthopedics/ Accessed 7/21/21

⁵Clarke H., Soneji N., Ko D.T., Yun L., Wijeysundera D.N. Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. BMJ. 2014;348:g1251. doi: 10.1136/bmj.g1251.

⁶DeFranco M.J., Walch G. Current issues in reverse total shoulder arthroplasty. J Musculoskelet Med. 2011;28:85–94

⁷Sabatino M.J., Kunkel S.T., Ramkumar D.B., Keeney B.J., Jevsevar D.S. Excess opioid medication and variation in prescribing patterns following common orthopaedic procedures. J Bone Joint Surg Am. 2018;100:180–188. doi: 10.2106/JBJS.17.00672.

⁸Goesling J, Moser SE, Zaidi B, et al. Trends and predictors of opioid use after total knee and total hip arthroplasty. Pain. 2016;157(6):1259-1265. doi:10.1097/j.pain.0000000000000516)

⁹Bevilacqua L, Goldman D. Genes and addictions. Clin Pharmacol Ther. 2009; 85(4):359–361. doi:10.1038/clpt.2009.6