Patients with preoperative opioid use and lower resilience scores are more likely to report inadequate pain control after total shoulder arthroplasty

Abstract

BackgroundThe United States is in a prescriptive opioid crisis, and physicians have a responsibility to their patients and the healthcare system to mitigate irresponsible prescriptive practices. A patient’s preoperative opioid status and brief resilience score (BRS) may be used to individualize analgesic protocols and reduce opioid overprescription. The purpose of this study is to evaluate the relationship between preoperative resilience scores and patient-reported pain control after total shoulder arthroplasty (TSA). This study also examines reported pain control in patients with or without preoperative narcotic use 30 days before their procedure. MethodsPatients undergoing elective primary anatomic total shoulder arthroplasty (aTSA) or primary reverse total shoulder arthroplasty (rTSA) were asked to complete the BRS survey before their procedure and postoperative narcotic pain medication surveys at 1, 4, and 12 weeks after their operation. The patients were then stratified into 2 cohorts based on preoperative opioid usage status. Two-sample equal-variance t-tests were used to test for differences between resilience score group means and adequate pain control after TSA. The differences between preoperative opioid and no preoperative opioid usage cohorts, and perceived pain control and the number of oxycodone pills taken were analyzed for direction and statistical significance using t-tests for continuous variables and chi-squared tests for categorical variables. ResultsThe study cohort consisted of 218 patients, of whom 74 had preoperative opioid use (group O). Patients who reported inadequate pain control after TSA had consistently lower resilience scores at baseline. The BRS group means ± standard deviations after TSA for the adequate vs. inadequate pain control groups respectively were 3.84 vs. 3.48 (P = .010) at week 1, 3.83 vs. 3.53 (P = .055) at week 4, and 3.84 vs. 3.36 (P = .002) at week 12. Of the patients in group O (n = 74), a consistently smaller proportion of patients reported adequate pain control after TSA. Pain control rates among group O vs. nonusers/opioid-naïve patients (group N) respectively were 81.1% vs. 89.6% (P = .080) at week 1, 83.8% vs. 92.4% (P = .055) at week 4, and 82.4% vs. 93.0% (P = .016) at week 12. ConclusionA patient’s resilience score and preoperative opioid consumption are associated with postoperative pain control. Physicians may be able to use these 2 preoperative measures to better individualize postoperative narcotic prescriptive practices and reduce the number of unused opioids.