Prolonged opioid use after primary total knee and total hip replacement: Prospective evaluation of risk factors and psychological profile for depression, pain catastrophizing and aberrant drug related behavior.

Abstract Background 40% patient continue to use opioids at 3 months after joint replacement. We sought to identify clinical and psychological risk factors associated with prolonged opioid use. Method In this prospective study psychological profile data was collected preoperatively. Prolonged use was defined as dispensation of an opioid after 90 days. Logistic regressions were used for univariate and multivariate modellings and to create receiver operating characteristic (ROC) curves. A backward stepwise regression analysis was used to select significant factors in the multivariable model. Results The study included 258 patients (163 TKR, 95 THR). 29.84% patients were on pre-operative opioids and 14% (37 out of 258) of patients had prolonged use of opioids. In the univariate analysis, age Conclusion Preoperative opioid use was the strongest predictor of post-operative prolonged opioid use. Younger age, associated backpain and chronic pain syndrome were the other identified risk factors. Screening tools to detect ADRB may be more helpful than those for depression or pain catastrophizing