- Title
- The impact of opioid medication on management, recovery, and outcomes of individuals with musculoskeletal disorders
- Creator
- Rhon, Daniel
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2021
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: Opioid-based medication for the treatment of non-cancer pain, including musculoskeletal pain, has been on the rise over the last three decades. Long-term opioid use is one consequence of prescribing opioids, that has the potential to strain many other health domains. The long-term adverse health effects associated with long-term opioid use have had relatively less investigation. There is a need to determine who is at risk for chronic opioid use, and for an improved understanding of long-term health effects associated with opioid use. Aims/Purpose: The primary aims of this thesis were to 1) determine predictors of long-term opioid use in patients with musculoskeletal disorders treated both surgically and non-surgically, 2) assess the bi-directional relationship between opioid utilization and health outcomes (past opioid use can affect future health outcomes, poor health outcomes can increase the risk for future opioid use) in patients with musculoskeletal disorders treated both surgically and non-surgically, and 3) investigate the consequences of opioid utilization as an initial treatment option when compared to other non-pharmacological treatment options. Methods: Two cohorts (N = 1870 and N = 87,578) extracted from US Military health data records from a database of close to 10 million active beneficiaries with lower extremity musculoskeletal pain were studied, all with a full 1-year look-back period and 2-year follow-up period. Relevant cases were identified for both knee and hip-related medical encounters as well as pain-related comorbidity encounters. Relevant regression modeling variations and risk statistics (e.g., 2x2 contingency tables) were used to determine question-specific outcomes within each cohort. Results: In a multivariate model, eight variables predicted chronic opioid use after surgery, across two different long-term opioid use definitions. Prior opioid use was identified as the strongest predictor of long-term opioid use in both surgical and non-surgical cohorts. Pain-related comorbidities that include sleep disorders, mental health disorders, substance abuse disorders, and cardiometabolic syndromes were slightly higher post-injury or post-surgery in patients with prior opioid use, and prior opioid use increased the risk for being diagnosed with one of these same pain-related comorbidities in the 2 years after injury. Prior opioid use was associated with a greater likelihood of recurrence and greater utilization of healthcare resources in patients treated non-surgically. When comparing timing and order of opioids and physical therapy after surgery, initiating physical therapy prior to filling an opioid prescription was associated with reduced injury-related costs and visits over the following two years compared to patients that filled an opioid prescription prior to receiving physical therapy. Conclusion: These findings provide evidence of how the health factors associated with musculoskeletal pain may be influenced by the utilization of opioids. Opioids are accompanied with many long-term consequences, many of which have had very little investigation to date. Comorbidity development and opioid use are associated and may have a bidirectional relationship, similar to the bidirectional relationship between sleep and pain. These relationships merit consideration when assessing patients with musculoskeletal pain and establishing their care plans. Clinical Implications: Plans of care for patients with musculoskeletal pain should include significant consideration around the topic of opioid use, to include prior use, risk for future use, and potential adverse health effects and comorbidities that could be exacerbated through the use of opioids long-term.
- Subject
- opioids; narcotics; musculoskeletal; secondary effects; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1511300
- Identifier
- uon:56480
- Rights
- Copyright 2021 Daniel Rhon
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 16 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 516 KB | Adobe Acrobat PDF | View Details Download |