April 12, 2021 – Opioid use for pain after shoulder replacement drops in study by SSM Health orthopedic surgeon Dr. Katherine Burns
Pain control after major surgery concerns patients and their doctors. Patients want to know their pain will be managed, and doctors want their patients to be comfortable without worrying about the side effects of prescription pain medication or addiction to opioids.
Dr. Katherine Burns, orthopedic surgeon and shoulder specialist at SSM Health DePaul Hospital, and her research team published two studies recently about pain medication used after shoulder surgery. One study, published in The Journal of Shoulder and Elbow Surgery, compared postoperative pain scores and opioid use for patients who participated in a blinded randomized controlled trial of a prescription anti-inflammatory medication or a placebo for three weeks after shoulder surgery. The trial was run for patients undergoing shoulder arthroplasty or rotator cuff repair.
“For people who need joint replacement, managing pain already is a concern,” said Dr. Burns. “Our patients are more aware now of the opioid crisis, and it has changed doctors’ approach to pain to provide an effective treatment that can avoid concern for opioid overuse and abuse.”
The study found that patients who underwent shoulder surgery and used the study medication needed less opioid medication to manage their pain.
“Celecoxib is useful with opioid medications in controlling early postoperative pain for patients undergoing shoulder surgery,” she said. “Overall the use of opioids for pain at 3 weeks and at 6 weeks was significantly lower in the group of patients undergoing total shoulder replacement who took the active medication.”
The full article can be found at: https://pubmed.ncbi.nlm.nih.gov/32919045/
A secondary study evaluated tendon healing in patients who had rotator cuff repair and had participated in the study medication trial. Dr. Burns received a grant from the Ruth Jackson Orthopedic Society in 2015 to fund this study. Patients were offered the opportunity to have an MRI at no cost to evaluate their surgical shoulder at one year after surgery. Tendon healing at one year after surgery is considered complete.
Dr. Burns enlisted the aid of SSM Health radiologist Dr. Nomi Siddiqui to read the imaging for patients who agreed to the MRI. Approximately half of the patients who received the study medication had a fully healed repair, compared with 70% of patients who received the placebo medication.
“It is difficult to determine whether the medication affected tendon healing, but some evidence suggests that anti-inflammatory medication can interfere with healing,” says Dr. Burns. “Use of anti-inflammatory medication for tendon healing has been inconclusive in the orthopedic literature, and we hoped this study could help determine the effect.”
Because less than half the patients in the full study volunteered to participate in this second part of the study, and the study results were mixed, Dr. Burns recommends against the use of celecoxib after rotator cuff repair at this time, out of an abundance of caution. This study was published online in JSES International.
The full article for this study can be found at: https://pubmed.ncbi.nlm.nih.gov/33681844/Leave a reply