“I Would Definitely Go In and Say, We Can Back Off Some Now.” Preoperative Attitudes Toward Post-Operative Opioid Reduction Among Patients Undergoing Total Joint Arthroplasty

Most patients who receive long-term opioid therapy (LTOT) prior to total joint arthroplasty (TJA) continue them after surgery. Since the intention of TJA is to improve pain though, lower opioid requirements postoperatively may be a reasonable expectation. Expectations regarding postoperative opioid requirements among LTOT recipients have not been explored. We conducted structured in-depth interviews with LTOT recipients prior to total knee or hip arthroplasty to guide the development of an opioid taper intervention. Interviews elicited perspectives on how TJA might impact long-term pain and opioid requirements. We analyzed interview transcripts using thematic content analysis, and here we report findings from the first 11 participants. Most participants had multisite pain, with some having their worst pain at the affected knee or hip. Participants were universally hopeful that surgery would reduce pain at the affected joint, which they anticipated would at least somewhat alleviate their total pain situation. Most were also anticipating that overall pain would increase temporarily after surgery. Most participants affirmed an expectation that they would be able to decrease or stop chronic opioid therapy at some point after surgery. However, very few had discussed reductions with their prescribers, or considered the specifics of how such reductions might occur. We conclude that patients may be open to decreasing opioid doses after TJA, but the lack of preoperative discussions of this matter may be a missed opportunity. Individualized conversations that take patients’ own aspirations into account could help clinicians and patients achieve opioid reductions to which they are often already open. Funded by the National Institutes of Health (K23 AR080224).