Opioid use among patients with pain syndromes commonly seeking surgical consultation: A retrospective cohort

BACKGROUND: Surgeons often see patients with pain to exclude organic pathology and consider surgical treatment. We examined factors associated with long-term opioid therapy among patients with foot/ankle, anorectal, and temporomandibular joint pain to aid clinical decision making. METHODS: Using the IBM MarketScan® Research Database, we conducted a retrospective cohort analysis of patients aged 18–64 with a clinical encounter for foot/ankle, anorectal, or temporomandibular joint pain (January 2007–September 2015). Multivariable logistic regression was used to estimate adjusted odds ratios for factors associated with long-term opioid therapy, including age, sex, geographic region, pain condition, psychiatric diagnoses, and surgical procedures in the previous year. RESULTS: The majority of the cohort of 1,500,392 patients were women (61%). Within the year prior to the first clinical encounter for a pain diagnosis, 14% had an encounter for a psychiatric diagnosis, and 11% had undergone a surgical procedure. Long-term opioid therapy was received by 2.7%. After multivariable adjustment, older age (age 50–64 vs. 18–29: aOR 4.47, 95% CI 4.24–4.72, p < 0.001), region (South vs. Northeast, aOR 1.76, 95% CI 1.70–1.81, p < 0.001), recent surgical procedure (aOR 1.83, 95% CI 1.78–1.87, p < 0.001), male sex (aOR 1.14, 95% CI 1.12–1.16, p < 0.001) and recent psychiatric diagnosis (aOR 2.49, 95% CI 2.43–2.54, p < 0.001) were independently associated with long-term opioid therapy. CONCLUSION: Among patients with foot/ankle, anorectal, or temporomandibular joint pain, the risk of long-term opioid therapy significantly increased with older age, recent psychiatric diagnoses and surgical history. Surgeons should be aware of these risk factors in order to make high quality clinical decisions in consultations with these patients.