Effects of preoperative opioid education on postoperative opioid use and pain management in orthopaedics: A systematic review

Prescription opioid abuse after surgery is considered a crisis in the United States. The objective of this systematic review was to evaluate use and effectiveness of pre-operative education with respect to post-operative opioid use and management of pain in the orthopaedic setting. Electronic searches were conducted in Ovid/Medline and SCOPUS to identify articles that discuss pre-operative opioid education and its effects on post-operative pain scores and prescription fulfillment. Non-orthopaedic studies were included for comparison. Eleven studies met inclusion criteria, 3 of which were retrospective reviews of large (>1000) post-surgical cohorts, and 8 of which were randomized controlled studies that examined different approaches to opioid education. Best current evidence suggests that incidence of opioid abuse after surgery is 5.9-6.5% and that the internet is the main source of guidance for patients regarding postoperative pain management. Education specifically related to opioid use and pain can be effective in reducing opioid prescription requests and filling. In contrast, education related solely to postoperative expectations does not consistently impact post-operative pain scores and was associated with 44% of total joint arthroplasty patients stating the approach was unhelpful regarding their pain management. This systematic review suggests that it is most effective to give patients verbal information rather than only providing information in written form and that utilizing two forms of education is most effective. The current literature supports this multi-modal approach to preoperative opioid education preoperatively for reducing post-operative opioid use and severity of self-reported pain.