title: Use of prescription analgesic medication and pain catastrophizing after total joint replacement surgery.
abstract: OBJECTIVE
  To survey the use of analgesic medication 4.8 years after total joint replacement (TJR) surgery and assess the determinants of medication usage.
  
  
  METHODS
  Of 852 patients who had undergone TJR for osteoarthritis were recruited from secondary care. Participants (mean age, 73.7 years) responded to a questionnaire on medication use, physical function and pain (WOMAC, VAS and body pain), pain catastrophizing and illness behaviour (somatization).
  
  
  RESULTS
  Only 37% of study participants were not on any pain relief medication, 25.1% were taking opioids, 6.9% were taking prescription NSAIDs and 25.9% were taking only non-prescription analgesics. Use of NSAIDs correlated with presence of back pain, body pain and high illness behaviour. The strongest associations with use of opioids were severe joint pain, high pain catastrophizing, body and back pain. After adjustment for covariates plus presence of pain, catastrophizing remained significantly associated with higher risk of opioid use (OR = 1.66, 95% CI: 1.13-2.43, p < 0.009) and of other prescription medication that can be used to treat pain (anti-depressants, anti-epileptics and hypnotics) (OR = 2.52, 95% CI: 1.61-3.95, p < 0.0005).
  
  
  CONCLUSIONS
  Use of opioid medication 4 years post-TJR is very high in our study population. In addition to joint, back and body pain, a major contributor to opioid use is pain catastrophizing. Our data suggest that current opioid and other analgesic prescribing patterns may benefit from considering the catastrophizing characteristics of patients.
authors.affiliation: Academic Rheumatology, Nottingham City Hospital, Clinical Sciences Building, Hucknall Rd, Nottingham NG5 1PB, UK; Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK. Electronic address: ana.valdes@nottingham.ac.uk.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Valdes
authors.affiliation: Academic Rheumatology, Nottingham City Hospital, Clinical Sciences Building, Hucknall Rd, Nottingham NG5 1PB, UK.
authors.forename: Sophie C
authors.initials: SC
authors.lastname: Warner
authors.affiliation: Academic Rheumatology, Nottingham City Hospital, Clinical Sciences Building, Hucknall Rd, Nottingham NG5 1PB, UK.
authors.forename: Hollie L
authors.initials: HL
authors.lastname: Harvey
authors.affiliation: Academic Rheumatology, Nottingham City Hospital, Clinical Sciences Building, Hucknall Rd, Nottingham NG5 1PB, UK; Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, UK.
authors.forename: Gwen S
authors.initials: GS
authors.lastname: Fernandes
authors.affiliation: Academic Rheumatology, Nottingham City Hospital, Clinical Sciences Building, Hucknall Rd, Nottingham NG5 1PB, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Doherty
authors.affiliation: Academic Rheumatology, Nottingham City Hospital, Clinical Sciences Building, Hucknall Rd, Nottingham NG5 1PB, UK.
authors.forename: Wendy
authors.initials: W
authors.lastname: Jenkins
authors.affiliation: Academic Rheumatology, Nottingham City Hospital, Clinical Sciences Building, Hucknall Rd, Nottingham NG5 1PB, UK; Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK.
authors.forename: Maggie
authors.initials: M
authors.lastname: Wheeler
authors.affiliation: Academic Rheumatology, Nottingham City Hospital, Clinical Sciences Building, Hucknall Rd, Nottingham NG5 1PB, UK; Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Doherty
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D058443:Catastrophization / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology; D016896:Treatment Outcome
chemical_list: D000700:Analgesics
keywords: Opioids; Osteoarthritis; Pain catastrophizing; Total joint replacement