Opioid use and posttraumatic stress disorder among veterans have been in the news. Is there a relationship between the two? For veterans who undergo elective ambulatory knee arthroscopy, is PTSD a risk factor for chronic postoperative pain, and are these veterans likely to use postoperative opioids for longer than 3 months? Dr. Irene Rozet, Department of Anesthesiology and Pain Medicine, University of Washington, and Department of Veterans Affairs, Puget Sound Health Care System, Seattle, Washington, and coauthors performed a retrospective cohort study of US veterans 18-50 years of age at their institution. The results of this analysis are described in the article “Prolonged Opioid Use After Knee Arthroscopy in Military Veterans,” which was published in this month’s edition of Anesthesia & Analgesia.
Identification of patients with PTSD was based on the diagnosis appearing in the patient’s “Problem List” or by reviewing clinic notes describing the patient’s mental health and psychological status. 145 patients were identified and of those patients, 47 were diagnosed as having PTSD. Chronic postoperative pain, measured here as “prolonged postoperative opioid prescription (PPOP)” longer than 3 months after the surgery, was seen in 30% of patients. The most important predictor of chronic postoperative pain was preoperative opioid use. Of those not taking opioids before surgery, the important predictors of pain were age > 27.5 years and PTSD. Of those taking opioids before surgery, the next most important predictors of postoperative pain, i.e., opioid use, were arterial hypertension and nonsmoking status.
This was a retrospective analysis and a prospective analysis is in order. In addition, of those veterans who were using opioids preoperatively, it is unclear whether they were taking the drugs because of knee pain or for other reasons.