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Sep 20, 2019

Orthopaedic Trauma Association

01 - A Pilot Study: Mental Health Support May Reduce Postinjury Opioid Use in Orthopaedic Trauma Patients Who Screen Positive for PTSD

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Opioids

traumatic injury

PTSD

Abstract

Abstract

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Keywords

Opioids

traumatic injury

PTSD

Abstract

Purpose: The perception of pain is multifactorial. There is evidence to suggest that psychiatric conditions, such as Post-traumatic Stress Disorder (PTSD), can reduce the ability to cope with painful stimuli and may be associated with catastrophizing. The purpose of this pilot study was to assess the viability of a program aimed at providing PTSD screenings, and offering mental health services, to adult trauma patients, and whether such interventions can reduce overall post-injury opioid use. Methods: This study included adult trauma patients treated at a level 1 trauma center from 2017-2018 (N=411). Patient demographic and injury information was collected. All patients were screened for PTSD with the PCL-5 survey following the injury. For patients who screened positive, a counselor attempted to contact them to offer counseling, support groups, and/or services of a psychologist or psychiatrist. The number of patients who were able to be contacted, and accepted support, was recorded. A subset of this population included patients with operatively managed orthopaedic fractures (N=152). From this subset, patients who screened positive for PTSD were evaluated in two groups: those who received mental health support, and those that did not. The amount of opioid pain medication dispensed from discharge to one year following injury was collected from the automated state prescription reporting system and compared between the two groups. Patients on long-term opioid maintenance therapy prior to the injury were excluded. All opioid medication was converted to morphine milligram equivalents (MME). Results: Of the 411 patients evaluated, 90 (21.9%) screened positive for PTSD. Of those patients who screened positive, 34 patients (37.8%) were able to be contacted, and accepted, one or more of the offered mental health services (12 for coaching, 9 for group support, 15 for rehabilitation psychology referral). In the orthopaedic fracture group (N=152), 32 (21.1%) screened positive for PTSD, and 14 patients (43.8%) received one or more of the offered mental health services. At one-year post-injury, total opioid use in patients receiving mental health services was 956 MME, compared to 1534 MME in patients who screened positive but did not undergo mental health interventions (p=0.36). Conclusion: Psychiatric conditions may influence pain perception following traumatic injury. This pilot study demonstrates that a program to screen for PTSD in trauma patients, and offer mental health interventions, is viable. Though underpowered to see statistically significant differences, this study also suggests that providing mental health services to trauma patients who screen positive for PTSD may reduce post-discharge opioid use. Further study, including multivariable statistical analysis in a larger sample, appears worthwhile.

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© Copyright 2019 Morressier GmbH.
All rights reserved.