Tracking Pain, Opioid, and Non-Opioid Use in a Total Knee Arthroplasty Patient Population through an Internet-Based Portal

Authors: Vivian Papas, BS¹  ; Sarah Ulcoq, BAppSc, MOT, OTR/L²  ; Seong Kim, MPH²  ; Giles R.  Scuderi, MD¹

¹Department of Orthopedics, Lenox Hill Hospital, New York, NY.

‍²Force Therapeutics, New York, NY.

ABSTRACT

Introduction

Amidst the current opioid crisis, there is an increasing concern about overprescribing opioids and need to evaluate various methods for pain control after total knee   arthroplasty (TKA). Real-time tracking of pain medication after TKA is crucial to manage   postoperative pain and monitor consumption of opioid and non-opioid medications. The study   purpose is to understand the relationship between postoperative patient reported pain and   consumption of both opioid and non-opioid medications after TKA using an internet-based   portal.

Methods

Patients undergoing primary TKA between March 2018 to April 2019 and enrolled on an internet-based portal were included in this study. All procedures were completed by one   surgeon. Once before surgery and for 30 days after surgery, patients were asked to complete   surveys about their pain management as they recover via the internet-based portal. The form   included questions about pain level (0-10), name of medication (opioid and non-opioid), number   of pills taken and side effects of these medications. Daily morphine equivalent doses were   calculated and average daily morphine equivalent dose were categorized by postoperative week. Pain levels were analyzed in a similar fashion

Results

Average reported pain and daily morphine equivalent dosage decreased significantly across each postoperative week. Patient pain levels were positively correlated with consumption   of opioids only at week 3 and week 4 postoperative (p<0.05). Non-opioid pill consumption   decreased from 3.60 pills to 2.65 pills from week 1 to week 4 (p<0.05). Three weeks after   surgery, patients reported greater number of daily non-opioid pills than opioid pills.

Conclusion

The results of this study revealed that there was a shift in opioid and non-opioid  consumption three weeks after surgery. This change in medication pattern aligned with the same   period of time when pain levels significantly correlated with opioid consumption. Monitoring   pain and medication intake through the internet-based portal was successful and can help identify  patients at risk of opioid overdose or who need additional attention for pain management. The three-week postoperative period will be a good opportunity for physicians to educate and support  patients to select appropriate pain management options.