Preoperative attitudes about post-operative pain and opioids among patients on long-term opioid therapy undergoing total joint arthroplasty.

OBJECTIVE: We aimed to understand the attitudes of patients on long-term opioid therapy (LTOT) about how upcoming total joint arthroplasty (TJA) would affect their future pain and opioid use. DESIGN: Semistructured, in-depth interviews were conducted. SETTING: A single academic medical center in the southern United States. PARTICIPANTS: Fifteen patients who were receiving LTOT and were scheduled to undergo total knee or hip arthroplasty. INTERVENTIONS: None. MAIN OUTCOME MEASURE: We used the Theory of Planned Behavior to inform our semistructured interview questions, exploring behavioral, normative, and control beliefs related to participants' current opioid use and how TJA might affect their intentions regarding their continued opioid requirements. We analyzed interview transcripts using thematic content analysis. RESULTS: Most participants had multisite pain, with some reporting their worst pain at the affected knee or hip. Participants perceived that their current opioid use improved their pain and functioning. They expected that they would be able to decrease or stop chronic opioid therapy at some point after surgery but saw future reductions as largely contingent on improved pain. Despite the expressed desire to take less opioids, participants were uncertain about the specifics of how those reductions would occur, and very few had discussed post-operative plans with their prescribers. CONCLUSIONS: Patients may be open to decreasing opioid doses after TJA, but the lack of preoperative planning may be a missed opportunity. Individualized conversations that take patients' own aspirations into account could help clinicians and patients achieve opioid reductions.