Baseline Opioid Medication Use is Associated with Greater Levels of Functional and Psychological Impairment among Hand Clinic Patients
Andrew Stephens, MS1; Andrew R Tyser, MD2; Nikolas H Kazmers, MD MSE1
1University of Utah, Salt Lake City, UT, 2Department of Orthopaedics, University of Utah, Salt Lake City, UT
Introduction: The association between baseline opiate use and perceived upper extremity function and pain among new hand surgery clinic patients is unclear. We hypothesize that baseline opiate use is associated with worse patient reported outcomes (PROs) in this population.
Materials & Methods: New patient visits for adults (?18 years) presenting to a tertiary academic orthopaedic non-shoulder hand and upper extremity clinic between February 2014 and April 2018 were eligible. Prospectively-collected PROs include the question "Are you currently taking narcotic pain medications?", the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE) Computer Adaptive Test (CAT), QuickDASH, PROMIS Physical Function (PF) CAT, PROMIS Pain Interference (PI) CAT, PROMIS Depression CAT, and PROMIS Anxiety CAT. Patients responding to the opioid question and at least one PROs were included. Postoperative and return visits were excluded. Multivariable logistic regression modelling was used to assess factors associated with PROs.
Results: Of 6864 included patients, 1212 (17.7%) reported currently using opiates. Mean age (49.3 ± 16.8yr) and percentage of female patients (55.8%) were not different between groups using and not using opiates (p = 0.26 and p = 0.07, respectively). All PROs were significantly worse in the opiate group (p < 0.001; Figure 1). A greater proportion of opiate users had PROMIS Depression CAT scores > 60 (associated with a clinical diagnosis of depression) at 19.1% versus 6.2% (p < 0.001). Opiate use was associated with significantly worse functional PROs after controlling for age, sex, and either depression (UE CAT -7.9, QuickDASH +19.7, and PF CAT -7.7 points; p < 0.001) or pain interference (UE CAT -3.6, QuickDASH +9.0, and PF CAT -4.4 points; p < 0.001). Pain interference was greater among opiate users when controlling for age, sex, and baseline function or psychological status (p < 0.001): PI was 2.7, 5.7, or 4.9 points greater when controlling for the PROMIS UE CAT, Depression CAT, or Anxiety CAT.
Conclusions: New patients presenting to a hand and upper extremity clinic who use opiate medications at baseline report significantly decreased physical function and increased psychological disability, with magnitudes of difference that are likely clinically-significant. Perhaps counterintuitively, opiate users reported greater levels of pain interference than patients not using opiates. These relationships should be considered when measuring and interpreting PROs among hand surgery patients.
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