Cause for Concern

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Higher opioid use found in younger, depressed patients awaiting surgery for osteoarthritis.
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This study reported a link between opioid use and depression, a serious mental illness that affects one in four Canadians at some point in their lives.

The opioid debate is complex: while opioid medications can be beneficial for pain management, in some cases they have been linked to worse outcomes and addiction.

This debate is particularly relevant to osteoarthritis—a condition that can cause persistent and often debilitating joint pain that worsens over time. Along with pain medication, surgery to replace affected joints is often a last resort.

“There exists a lot of unknowns regarding the use of opioid medication in this setting,” says Krembil Clinician Investigator Dr. Raja Rampersaud. “Few guidelines exist on the proper use of opioids for managing osteoarthritis-related pain, and recent evidence suggests that these medications are ineffective. As well, there is increasing evidence that opioid use in these patients may lead to worse surgery outcomes.”

To shed more light on this issue, Dr. Rampersaud and his collaborators initiated a study to explore the effect of opioid use and other factors—such as body mass index, age, level of education and health status—on the outcomes of patients with end-stage osteoarthritis having surgery.

“After analyzing data for over 1,125 patients, we found some concerning trends,” says Dr. Rampersaud. The study revealed that a large proportion of osteoarthritis patients—up to one third—are using opioids. Furthermore, opioid use was higher in younger individuals (those under 65 years of age) and those experiencing symptoms of depression.

“Our findings provide compelling evidence that more rigorous guidelines, and effective and timely alternatives are needed to protect individuals with osteoarthritis from the potential harms of opioid use. Also, given that recent studies have linked opioid use to worse surgical outcomes, carefully considering patient factors, such as age and mental health, could help to counteract these effects and improve the lives of those with osteoarthritis.”

This work was supported by University Health Network’s Arthritis Program and the Toronto General & Western Hospital Foundation.

Power JD, Perruccio AV, Gandhi R, Veillette C, Davey JR, Lewis SJ, Syed K, Mahomed NN, Rampersaud YR. Factors Associated With Opioid Use in Pre-surgical Knee, Hip and Spine Osteoarthritis Patients. Arthritis Care Res (Hoboken). 2019 Jan 10. doi: 10.1002/acr.23831.

Dr. Raja Rampersaud, Clinician Investigator, Krembil Research Institute. Photo courtesy of the Globe and Mail.