Opioids, Arthritis and Joint Replacement

Reducing the prescription and use of opioids through education of patients and physicians managing osteoarthritis
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I’m taking opioids now or thinking of taking them.

I'm not sure I'm taking opioids. What are opioids?
Opioids are powerful prescription pain reducing medications that have benefits and potentially serious risks. Common opioid medications prescribed include oxycodone, hydrocodone, morphine, Norco (acetaminophen/hydrocodone), Vicodin (acetaminophen/hydrocodone), Percocet (acetaminophen/oxycodone), hydromorphone (Dilaudid), and tramadol.
Should I be taking opioids for hip or knee arthritis pain? What are the risks?
If you suffer from arthritis pain, multiple strategies other than using opioids should be tried for pain control before surgery. Potential therapies include nonsteroidal anti-inflammatories (NSAIDs), acetaminophen, injections, weight loss, and physical therapy. Read this article about how to relieve hip and knee pain without surgery.

People who are taking opioids and have joint replacement surgery are at increased risk for complications after surgery. These risks include infection, needing a second surgery and becoming dependent on opioids. It can also be much more challenging to control pain after surgery, and chances are greater that you won’t be satisfied with the results of your surgery.

Read this article, “Opioid Use Before Hip or Knee Surgery Can Mean Trouble.”

If you are currently taking opioids for arthritis related pain, you should work with your doctor to develop a plan to wean off opioids.

Can I take opioids for pain before my joint replacement surgery and then stop after surgery?
You are strongly discouraged from taking opioids for arthritis pain prior to joint replacement surgery. Studies show that people who do not use opioids prior to surgery are less likely to need opioids in the months after surgery and will have a better outcome after surgery.

It is important to discuss this subject with your physician and work together as a team to develop an opioid-free plan that works best for you.

I just had joint replacement surgery and was prescribed an opioid for pain. Can I take something else instead?
You should discuss with your doctor to see if you are eligible to take non-opioid pain relievers such as acetaminophen (Tylenol), non-steroidal anti-inflammatories (e.g. Celebrex), and/or gabapentinoids (e.g. Neurontin or Lyrica). Opioid pain medications should be used as a last resort after trying non-opioid pain relievers. If you’re taking an opioid, you should take the lowest dose of opioids possible and stop taking them as soon as possible.
Where should I store my opioid pain medication? And how do I get rid of leftover medication?
Opioids are a leading cause of serious poisoning of children and pets when they are left unsecured. Opioids should be hidden or in a locked cabinet so that they cannot be accessed by family, friends or guests. Opioids pills should be left in their original prescription bottle with the label on so it is clear for whom the medications were prescribed and how the medication should be taken.

Leftover opioid pills should be discarded as soon as possible. For a list of best choices for disposal of unused or expired medicines, visit the FDA’s website.

I’m caring for someone who needs pain relief.

What is the AAHKS position on prescribing opioids?
It is our position that the use of opioids for the treatment of osteoarthritis of the hip and knee should be avoided and reserved for only for exceptional circumstances.

Opioids, when compared to non-opioid medications, do not provide superior long-term pain relief when used for the treatment of hip and knee arthritis. The use of opioids for treatment of hip and knee arthritis, especially prior to surgery, must be questioned.

My patient has osteoarthritis. What's the best way to manage pain?
Opioids should not be used as a first line treatment for either acute or chronic symptoms of hip or knee osteoarthritis. Non-opioid treatment modalities should be used instead. These include nonsteroidal anti-inflammatories (NSAIDs), acetaminophen, injections, weight loss, and physical therapy.

As an alternative to opioids, orthopaedic surgeons and other providers of musculoskeletal care should strongly consider the recommendations of the American Academy of Orthopaedic Surgeons Clinical Practice Guidelines on nonsurgical treatment and non-arthroplasty treatment of hip and knee arthritis.

Non-opioid treatments have failed, and opioids are the only option. Is there a safe prescribing protocol?
When other non-opioid treatment modalities have failed and patients cannot undergo joint replacement surgery, opioid use may be considered in an extremely small subset of patients. These patients who are prescribed opioids for nonoperative treatment of osteoarthritis should be educated on the risks of prolonged opioid use including addiction and dependency.

The fewest number of opioids in the lowest dose, and for the shortest time possible should be prescribed.

For patients who may require more prolonged opioid use, strong consideration should be given to referral to a pain management specialist.

Patients should be educated on safe storage of opioid pain medications and proper disposal when opioids are no longer needed.

Is there a pamplet I can provide my patients to educate them on the risks of using opioids?
The AAHKS Patient and Public Relations Committee has written this article, “Opioid Use Before Hip or Knee Surgery Can Mean Trouble,” which is available online and as a PDF download that you can print.

Help from the Medical Community

Using Opioids for Arthritis

It is our position that the use of opioids for the treatment of osteoarthritis of the hip and knee should be avoided and reserved for only for exceptional circumstances. Read the full statement.

Managing Pain Safely

Given the dangers of prescription opioids, how can you safely and effectively manage pain?  Physicians are working together to change the culture of pain management, with the ultimate goal of significantly reducing opioid use and misuse. Visit OrthoInfo.org.

Providing Statistics

Opioids killed more than 130 people per day in 2017. This infographic from the Centers for Medicare & Medicaid Services details statistics, key areas of focus, successes and more. Download the Roadmap.

Disposing of Pills Properly

When your medicines are no longer needed, they should be disposed of promptly. The US Food & Drug Administration provides practical ways you can dispose of expired, unwanted or unused medicines. Visit FDA.gov/DrugDisposal.

Educate Yourself on Opioid Use

Opioid Use Before Hip or Knee Surgery Can Mean Trouble

The AAHKS Patient and Public Relations Committee worked with the Evidence Based Medicine Committee and a special task force on opioids to provide information to people with joint pain who are either currently taking opioids or wondering if they should start. The article answers these questions and more:

  1. What are opioids?
  2. Will taking opioids affect the outcome of my joint surgery?
  3. If I can’t take opioids for pain, what can I take?

Read the article online.

More Resources for Physicians and Care Providers

National Institute on Health National Institute on Drug Abuse

The latest science, trends and statistics.

National Safety Council Prescription Drug Employer Toolkit

Resources for employers about opioid use and misuse in the workplace.

American College of Surgeons

Resources to address surgical patient opioid use.

American Medical Association End the Epidemic

Taskforce recommendations for physicians.
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