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Strategies to Standardize Opioid Research and Improve Clinical Pain Management

      Abstract

      Opioid abuse results in poor pain control, poor outcomes, and addiction. Clinical recommendations to manage pain include identifying the problem, considering multimodal anesthesia, avoiding overprescribing, acknowledging that minimizing opioid use is not equivalent to undertreating pain, minimizing preoperative opioid use, managing patient expectations, and continuing to investigate outcomes of pain management while limiting opioid prescriptions or forgoing opioids altogether. Authors are directed to new Recommendations for Pain Management Research to highlight critical research parameters and standardize outcome reporting.
      Knowing that opioid addiction and abuse yield poor pain control, poor clinical outcomes, and addiction, the orthopaedic community must continue the quest for improved research to optimally manage pain. A step in the right direction is the joint editorial by Heckman et al., “Pain Management Research,”
      • Heckman J.D.
      • Swiontkowski M.
      • Katz J.N.
      • Losina E.
      • Schoenfeld A.J.
      • Bedard N.A.
      • Bono C.M.
      • Carey J.L.
      • Graham B.
      • Hensinger R.N.
      • Gebhardt M.C.
      • Mallon W.J.
      • Rossi M.J.
      • Matzkin E.
      • Pinzur M.S.
      Pain management research.
      which precedes this editorial, and the “Recommendations for Pain Management Research,”
      Recommendations for pain management research.
      which follow this editorial and are based on a Pain Management Research Symposium hosted by The Journal of Bone and Joint Surgery and attended by Arthroscopy Assistant Editor-in-Chief Michael Rossi and Associate Editor Elizabeth Matzkin.
      The “Recommendations for Pain Management Research” provide an excellent addition to the following clinical recommendations we proposed in a 2019 editorial, “Opioids After Arthroscopy: We’re Only Halfway Through the Crisis”:
      • identify the problem
      • consider multimodal anesthesia
      • avoid overprescribing
      • acknowledge that minimizing opioid use is not equivalent to undertreating pain
      • minimize preoperative opioid use
      • manage patient expectations
      • continue to investigate outcomes of pain management
      • limit opioid prescriptions or forgo opioids altogether.”
        • Rossi M.J.
        • Brand J.C.
        • Lubowitz J.H.
        Opioids after arthroscopy: We’re only halfway through the crisis.
      We advise our readers to consider our aforementioned clinical recommendations, and we implore our authors to follow the new research recommendations. Compliance with the research recommendations will ensure that the most important parameters having an effect on pain management are thoughtfully considered and will standardize outcome reporting to facilitate comparison of related research, systematic review, and meta-analysis.
      Taken in sum, our goal is to mitigate against opioid abuse and improve safety and outcomes in an evidence-based manner as we develop alternative and/or combined approaches to manage pain.

      References

        • Heckman J.D.
        • Swiontkowski M.
        • Katz J.N.
        • Losina E.
        • Schoenfeld A.J.
        • Bedard N.A.
        • Bono C.M.
        • Carey J.L.
        • Graham B.
        • Hensinger R.N.
        • Gebhardt M.C.
        • Mallon W.J.
        • Rossi M.J.
        • Matzkin E.
        • Pinzur M.S.
        Pain management research.
        J Bone Joint Surg Am. 2020; 102: 855
      1. Recommendations for pain management research.
        J Bone Joint Surg Am. 2020; 102 (61)
        • Rossi M.J.
        • Brand J.C.
        • Lubowitz J.H.
        Opioids after arthroscopy: We’re only halfway through the crisis.
        Arthroscopy. 2019; 35: 1633