Opioids Before Knee Replacement Increase Pain After Surgery

By Chris Centeno, MD /

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opioids and knee replacement

If you have knee pain that over-the-counter medications haven’t seemed to touch, your doctor may prescribe an opioid, a more powerful narcotic medication. However, if you are considering a knee replacement, a new study suggests opioids and knee replacement is a problematic combination and you may want to rethink the opioid. In fact, you may want to rethink the knee replacement, too, but I’ll get to that later. First, let’s look at opioids and the new study.

What You Need to Know About Opioids

Opioids include prescription drugs such as codeine, hydrocodone, Lorcet, Vicodin, methadone, morphine, oxycodone, Percocet, and many more. They work by modifying the message that would normally relay to your brain that your knee, for example, hurts. On the surface, reducing the pain might seem like a great idea, but when we dive beneath, we see all the problems that come with opioid use.

The short-term use of narcotics can actually lead to chronic pain. I can’t emphasize this point enough. We actually have research that shows that taking an opioid medication rewires your pain sensors so that you feel more pain. So while these medications help the pain in the short run, they increase it in the long run.

Additionally, opioids are highly addictive drugs with 1 in 5 users becoming addicted with as little as a 10-day prescription. Because of this, the drugs require a weaning process to come off them to help control any withdrawal symptoms. We also know from a study I covered last year that compared to many other common surgeries, patients are five times more likely to follow up a knee replacement with a post-surgery narcotic addiction.

Today’s feature study reveals the issue of opioids and knee replacement is bigger than we realized as it isn’t just the use of these drugs following knee replacement—we also need to be concerned about issues with opioid use prior to knee replacement.

Opioids and Knee Replacement: The New Study on Opioid Use Prior to Knee Replacement

 The new study investigated if patients who used opioids prior to their knee replacement experienced more pain six months following the surgery than those who did not use opioids. Of the 156 subjects 23% had received at least one opioid prescription for pain within the two years prior to their surgery (9% had received multiple opioid prescriptions). On a scale of 100, the mean pain score for the non-opioid group reduced by 33.6 points (78%), while the mean pain score for the opioid group reduced by only 27 points (58%). Researchers, of course, concluded that patients who used opioids up to two years prior to their knee replacement had less reduction in pain following their surgery.

The researchers also pointed out central sensitization, where pain signals can actually become amplified due to narcotic or opioid use in patients with chronic pain. The idea here is that these patients may have had more central sensitization before the procedure or that it was caused by the opioids. We may never know for sure.

Opioid Use or Not, Eliminating Knee Pain Isn’t a Given with Knee Replacement

Most patients who undergo knee replacement do so to address their severe knee pain. If the pain isn’t truly as bad as the patient believes it is, and even if it is in many cases, we have to ask if knee replacement is the right option. I mentioned that you may want to rethink opioid use if knee replacement is in your future, but I also think you might want to rethink the knee replacement because knee pain often continues after knee replacement. Let’s review:

The upshot? Whether before knee replacement or after, or both, we know opioids and knee replacement are not a good combination as opioid use can negatively affect pain after the surgery. There’s also the interesting factoid that opioids can cause amplified pain (central sensitization), so by the time a patient decides to undergo a knee replacement, the patient may not even know what his or her true level of pain is. So while throwing risky, addictive opioids at the pain might be quick and easy, finding alternative ways to manage or address the pain would be a better solution for many patients.

Category: Knee, Latest News

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8 thoughts on “Opioids Before Knee Replacement Increase Pain After Surgery

  1. dieter Schaede

    opioids are given out irresponsible bei Doctors who don’t really know much about it
    i am a good example , i was only aware that the painkiller after my operation of knee replacement was given to me by a Dr . my pains increased i experienced depression
    for the first time in my live ,ending up in a hospital where it took 3 weeks to get me of the drug , and thats no fun.it is hell

    1. Regenexx Team Post author

      dieter,
      So sorry to hear that. Sadly, we hear this far too often. So glad that you were able to get off the medication!

  2. Debra

    For those of us with grade 4 osteoarthritis of the knee who are not candidates for knee replacement surgery due to medical conditions that make the surgery too risky for knee replacement what are we to do.? By stage 4 we are well past the point of physical therapy and have had stem cell transplants that are only limited effective. The knee pain is horrendous most of the time even at rest what options do we have?

    1. Regenexx Team Post author

      Debra,
      Pain is a horrible thing! The problem though is that Opioids make pain worse. They cause chronic pain, exagerate one’s experience of pain, and make things hurt that actually don’t. There are other options that would likely make you more comfortable. Please let us know if you’d like more information.

  3. Russ

    I recently got treated In Cayman for several areas of my body, knees and hips included. I am curious about those patients who are so bad that they have no choice but to attempt a hip or knee replacement. Are there currently legitimate tests available that can predict an allergy to the metals, plastics, and cements that are being used so that patients can know ahead of time before surgery that they will probably react to the materials. Is it routine for orthopedic surgeons to screen patients for these specific material allergies or do they just hope for the best.

    1. Regenexx Team Post author

      Russ,
      Yes, there are tests patients being considered for hip and knee replacements should be screened with. Not to mention exams to establish their hip or knee and not their back as the source of pain. Unfortunately, in most cases, neither is done.

  4. Rick Sweetibg

    You are absolutely correct — by far the majority of patients with non cancer MSK pain should not be prescribed opioids. However perhaps it would be of benefit to review a group of patients who have had a good result following knee arthroplasy, determine the relative severity, indications and procedures and use the findings to more accurately and effectively select patients for future surgery and not dwell only on negative statistical results.

    I am a 77 yo retired Orthopod and although it is only 2 1/2 years post op I am back to tennis, kayaking and hiking with no day to day pain stiffness, limp or holding on to a stair rail — only time will tell for the future function

    1. Regenexx Team Post author

      Rick,
      It would be a good idea as appropriate “indications” are definitely an issue. Great to hear you’re doing so well! There are situations in which knee replacement is necessary, and when it is, patients need to find the very best surgeon. Sadly though, aprox 1/3 of the knee replacements performed in the US are either inappropriate or medically unecessary. https://regenexx.com/blog/when-do-you-need-a-knee-replacement/ Additionally, patients are not screened appropriately for joint replacement today, meaning the joint has often not been established as the source of pain, and simple things like allergy testing is not routinely done. Please see: https://regenexx.com/blog/knee-replacement-outcomes-back-pain/ and https://regenexx.com/blog/low-back-and-hip-replacement-complications/ and https://regenexx.com/blog/knee-replacement-questions/

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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