title: Risk factors for continued opioid use one to two months after surgery for musculoskeletal trauma.
abstract: BACKGROUND
  The aim of this study was to determine factors associated with self-reported ongoing use of opioid medication one to two months after operative treatment of musculoskeletal trauma.
  
  
  METHODS
  Operatively treated patients (n = 145) with musculoskeletal trauma were evaluated one to two months after surgery. Patients indicated if they were taking opioid pain medication and completed several psychological questionnaires: the Center for Epidemiologic Studies Depression Scale, the Pain Catastrophizing Scale, the Pain Anxiety Symptoms Scale, and the Posttraumatic Stress Disorder Checklist, civilian version. The Numeric Rating Scale was used to measure pain intensity. Disability was measured with use of the Short Musculoskeletal Function Assessment Questionnaire and injury severity was measured with use of the Abbreviated Injury Scale.
  
  
  RESULTS
  Patients who scored higher on the catastrophic thinking, anxiety, posttraumatic stress disorder, and depression questionnaires were significantly more likely (p < 0.001) to report taking opioid pain medications one to two months after surgery, regardless of injury severity, fracture site, or treating surgeon. The magnitude of disability as measured by the Short Musculoskeletal Function Assessment score was significantly higher (p < 0.001) in the patients who reported using opioids (40 points) compared with those who reported not using opioids (24 points). A logistic regression model not including pain intensity found that the single best predictor of reported opioid use was catastrophic thinking (odds ratio, 1.12 [95% confidence interval, 1.07 to 1.18]), which explained 23% of the variance (p < 0.001).
  
  
  CONCLUSIONS
  Patients who continue to use opioid pain medication one to two months after surgery for musculoskeletal trauma have more psychological distress, less effective coping strategies, and greater symptoms and disability than patients who do not take opioids, irrespective of injury, surgical procedure, or surgeon.
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. E-mail address for G.T.T. Helmerhorst: ghelmerhorst@gmail.com. E-mail address for A.-M. Vranceanu: avranceanu@partners.org. E-mail address for.
authors.forename: Gijs T T
authors.initials: GT
authors.lastname: Helmerhorst
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. E-mail address for G.T.T. Helmerhorst: ghelmerhorst@gmail.com. E-mail address for A.-M. Vranceanu: avranceanu@partners.org. E-mail address for.
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Vranceanu
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. E-mail address for G.T.T. Helmerhorst: ghelmerhorst@gmail.com. E-mail address for A.-M. Vranceanu: avranceanu@partners.org. E-mail address for.
authors.forename: Mark
authors.initials: M
authors.lastname: Vrahas
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. E-mail address for G.T.T. Helmerhorst: ghelmerhorst@gmail.com. E-mail address for A.-M. Vranceanu: avranceanu@partners.org. E-mail address for.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Smith
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. E-mail address for G.T.T. Helmerhorst: ghelmerhorst@gmail.com. E-mail address for A.-M. Vranceanu: avranceanu@partners.org. E-mail address for.
authors.forename: David
authors.initials: D
authors.lastname: Ring
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology; D058443:Catastrophization / Q000175:diagnosis / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009141:Musculoskeletal System / Q000293:injuries*; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D012307:Risk Factors; D057566:Self Report; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid