title: Narcotic Use: A Modifiable Risk Factor for Hip and Knee Arthroplasty.
abstract: The use of opioids in the United States has become an epidemic. Opioids have become frequently prescribed for arthritic pain in the hip and knee. The use of opioidsas first-round therapy for pain has been driven by several factors, including the health care providers' lack of understanding that anti-inflammatory medications are at least as effective as opioids, a patient's expectation of complete pain relief on presentation to the emergency room or doctor's office, and increasing importance placed on patient satisfaction. The harmful effects of opioids are observed after joint replacement with long-term use leading to worse results after joint replacement. Decreasing the amount of opioids used before surgery improves outcomes after surgery. The use of opioids may be modified before surgery to give better surgical results. The goal of this review is to determine how opioid medications should fit into the treatment of arthritis pain, learn the guidelines for their use in arthritis, and understand how to educate health care providers that opioid use is a modifiable risk factor.
authors.affiliation: Department of Orthopaedic Surgery, University of Arkansas for Medical Services, Little Rock, Arkansas.
authors.forename: Robert M
authors.initials: RM
authors.lastname: O'Neal
authors.forename: Kipp A
authors.initials: KA
authors.lastname: Cryer
authors.forename: Paul K
authors.initials: PK
authors.lastname: Edwards
authors.forename: C Lowry
authors.initials: CL
authors.lastname: Barnes
authors.forename: Simon C
authors.initials: SC
authors.lastname: Mears
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D018771:Arthralgia / Q000628:therapy; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D006801:Humans; D015207:Osteoarthritis, Hip / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000628:therapy*; D059408:Pain Management; D017410:Practice Guidelines as Topic; D012307:Risk Factors
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal