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Regarding “Patient Satisfaction With Nonopioid Pain Management Following Arthroscopic Partial Meniscectomy and/or Chondroplasty”

      We read with great interest the study by Daniels et al.
      • Daniels S.
      • Garvey K.
      • Collins J.
      • Matzkin E.
      Patient satisfaction with nonopioid pain management following arthroscopic partial meniscectomy and/or chondroplasty.
      titled “Patient Satisfaction With Nonopioid Pain Management Following Arthroscopic Partial Meniscectomy and/or Chondroplasty.” We want to thank Daniels et al. for taking the time to explore the critical topic of non–opioid-mediated postsurgical pain management. In their single-center prospective study of 163 patients, they compared the patient satisfaction rate for opioid and non-opioid treatment after meniscectomy and chondroplasty. This article is of great interest to us as it evokes important topics by addressing the opioid over-prescription by orthopaedic surgeons.
      • Morris B.
      • Mir H.
      The opioid epidemic.
      Currently, as mentioned in the study, orthopaedic surgeons are the third-highest prescribers of opioids among American physicians.
      • Morris B.
      • Mir H.
      The opioid epidemic.
      With the opioid epidemic in full effect, there is a glaring and immediate need for alternative postoperative pain management in less involved operations.
      • Morris B.
      • Mir H.
      The opioid epidemic.
      As mentioned by Daniels et al. in their work, multiple studies have described non-opioid regimens in various procedures offering similar pain management to opioid regimens.
      • Alkhoury F.
      • Knight C.
      • Stylianos S.
      • et al.
      Prospective comparison of nonnarcotic versus narcotic outpatient oral analgesic use after laparoscopic appendectomy and early discharge.
      • Gimbel J.
      • Brugger A.
      • Zhao W.
      • Verburg K.
      • Geis G.
      Efficacy and tolerability of celecoxib versus hydrocodone/acetaminophen in the treatment of pain after ambulatory orthopedic surgery in adults.
      Daniels et al.
      • Daniels S.
      • Garvey K.
      • Collins J.
      • Matzkin E.
      Patient satisfaction with nonopioid pain management following arthroscopic partial meniscectomy and/or chondroplasty.
      did a great job collecting patient demographic characteristics such as age, body mass index, sex, race, preoperative depressive symptoms, and preoperative opioid use. It is mentioned in the limitations that the study was not sufficiently powered to show an association of patient satisfaction with demographic characteristics, and thus, nonsignificant findings do not eliminate a possible correlation.
      • Daniels S.
      • Garvey K.
      • Collins J.
      • Matzkin E.
      Patient satisfaction with nonopioid pain management following arthroscopic partial meniscectomy and/or chondroplasty.
      We believe including more detailed demographic characteristics would have allowed further clarification regarding patient satisfaction. Additional demographic characteristics would also better clarify the results and aid readers in understanding the satisfaction of certain patient populations with postoperative non-opioid treatment. Because this was a single-center study and although limited generalizability was referred to as a limitation, it is crucial to have detailed information regarding not only the general location of the study (i.e., suburban, urban, or rural) but also the patient population that is being studied. Specifically, using patient socioeconomic factors in patient demographic characteristics would allow for a more complete understanding of patient satisfaction and a possible correlation.
      In the current literature, patient education level has been shown to be correlated with opioid prescription use. Moreover, patients with a lower education level were shown to receive significantly more opioid prescriptions than their more highly educated peers.
      • Platts-Mills T.
      • Hunold K.
      • Bortsov A.
      • et al.
      More educated emergency department patients are less likely to receive opioids for acute pain.
      Somewhat contrarily, patients in the higher income quartile were significantly more likely to be prescribed opioids than patients with a lower income.
      • Joynt M.
      • Train M.
      • Robbins B.
      • Halterman J.
      • Caiola E.
      • Fortuna R.
      The impact of neighborhood socioeconomic status and race on the prescribing of opioids in emergency departments throughout the United States.
      These results were noted to be independent of sex and race.
      • Platts-Mills T.
      • Hunold K.
      • Bortsov A.
      • et al.
      More educated emergency department patients are less likely to receive opioids for acute pain.
      With disagreement between studies linking social demographic characteristics to opioid prescriptions, inclusion of education, income, and other social determinants of health in patient demographic characteristics would help better clarify the demographic characteristics correlated with higher non-opioid satisfaction rates and allow readers to understand which patient population was being studied.
      Nonetheless, we commend Daniels et al.
      • Daniels S.
      • Garvey K.
      • Collins J.
      • Matzkin E.
      Patient satisfaction with nonopioid pain management following arthroscopic partial meniscectomy and/or chondroplasty.
      on their exceptional work in evaluating postoperative non-opioid patient satisfaction. Ultimately, though, we believe inclusion of additional demographic characteristics, such as patient education and socioeconomic status, would provide greater clarity and potentially provide correlation between patient demographic characteristics and patient satisfaction with postoperative non-opioid prescriptions. We invite any clarification that would help further support the authors' findings and propose additional dialogue for future projects.

      Supplementary Data

      References

        • Daniels S.
        • Garvey K.
        • Collins J.
        • Matzkin E.
        Patient satisfaction with nonopioid pain management following arthroscopic partial meniscectomy and/or chondroplasty.
        Arthroscopy. 2019; 35: 1641-1647
        • Morris B.
        • Mir H.
        The opioid epidemic.
        J Am Acad Orthop Surg. 2015; 23: 267-271
        • Alkhoury F.
        • Knight C.
        • Stylianos S.
        • et al.
        Prospective comparison of nonnarcotic versus narcotic outpatient oral analgesic use after laparoscopic appendectomy and early discharge.
        Minim Invasive Surg. 2014; 2014: 509632
        • Gimbel J.
        • Brugger A.
        • Zhao W.
        • Verburg K.
        • Geis G.
        Efficacy and tolerability of celecoxib versus hydrocodone/acetaminophen in the treatment of pain after ambulatory orthopedic surgery in adults.
        Clin Ther. 2001; 23: 228-241
        • Platts-Mills T.
        • Hunold K.
        • Bortsov A.
        • et al.
        More educated emergency department patients are less likely to receive opioids for acute pain.
        Pain. 2012; 153: 967-973
        • Joynt M.
        • Train M.
        • Robbins B.
        • Halterman J.
        • Caiola E.
        • Fortuna R.
        The impact of neighborhood socioeconomic status and race on the prescribing of opioids in emergency departments throughout the United States.
        J Gen Intern Med. 2013; 28: 1604-1610

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