OBJECTIVES : Osteoarthritis is a chronic degenerative disease characterized by pain, stiffness, swelling, and reduced mobility. Pain management presents a major challenge for patients, with opioid use being prevalent. However, opioids are associated with multiple complications including narcotic bowel syndrome and opiate dependency. The objective of the present study was to examine opioid usage within an osteoarthritis patient cohort stratified by type of visit and patient-reported pain scores

METHODS : This retrospective study examined data from a U.S. electronic health record database (Cerner Health Facts®). Each patient visit (age ≥ 18 years) with a principal ICD9/10 diagnosis of osteoarthritis between 2012 and 2016 were included. Visit-based data for medications were examined for this cohort. ‘Opioid analgesics’ were identified as per the VA drug classification system (2016). The highest pain score per visit (Numeric Pain Scale 0-10) was used to assign a pain group (mild/moderate/severe) for every visit.

RESULTS : The study included 1.35 million osteoarthritis visits (62% female, 38% male), with a mean (standard deviation) age of 62.1 (13.3) years. Of the total visits, 16% (N=210,681) were inpatient stays. Opioid analgesics were prescribed in 15% (N=206,024) of total visits and in 80% (N=169,106) of all inpatient stays. Pain scores were available in 15% (N=198,951) of total visits, with patients reporting severe pain in 53% (N=105,068) of those visits. Opioid analgesics were prescribed in 20% (N=7,305), 28% (N=16,029), and 43% (N=45,488) of visits with a mild, moderate, or severe pain score, respectively.

CONCLUSIONS : This large database analysis examines patient-reported pain scores and opioid usage for osteoarthritis-related visits and provides initial insights into potentially relevant medication prescribing practices in both inpatient and non-inpatient settings. It highlights opioid use even in mild and moderate pain, especially when there are other non-opioid options indicated. Given the current opioid epidemic, there may be opportunities for improved prescribing.