Prolonged opioid use after distal radius fracture

BACKGROUND: Prolonged opioid use (more than 90 days) after injury puts the patient at risk for adverse effects. We investigated the patterns of opioid prescription after distal radius fracture and the effect of pre- and post-fracture factors on the risk for prolonged use.

METHODS: This register-based cohort study uses routinely collected health care data, including purchases of prescription opioids, in the county of Skåne, Sweden. 9369 adult patients with a radius fracture diagnosed 2015-2018 were followed for one year after fracture. We calculated proportions of patients with prolonged opioid use, both in total and according to different exposures. Using modified Poisson regression, we calculated adjusted risk ratios for the following exposures: previous opioid use, mental illness, consultation for pain, surgery for distal radius fracture and occupational/ physical therapy after fracture.

RESULTS: Prolonged opioid use (4-6 months after fracture) was found in 664 (7.1%) of the patients. A previous, but discontinued, regular use of opioids up to five years before fracture increased the risk compared to opioid naïve patients. Both regular and non-regular opioid use the year before fracture increased the risk. The risk was also higher for patients with mental illness, and those who were treated with surgery, we found no significant effect of pain consultation in previous year. Occupational/physical therapy lowered the risk for prolonged use.

CONCLUSION: Considering history of mental illness and previous opioid use while promoting rehabilitation can be important to prevent prolonged opioid use after distal radius fracture.