While the numbers of opioid prescriptions and overdose deaths in the United States recently have declined for the first time in years, experts continue to be concerned at how and why the painkilling medicines are being prescribed.

Once reserved for only the most severe kinds of pain, opioid medicines have been far more widely dispensed in recent years, in some cases without clinical evidence of their effectiveness and safety. Those prescribing practices are blamed for fueling the opioid crisis as users move on to heroin and fentanyl, chemical cousins of pharmaceuticals such as oxycodone.

Two recent studies highlight continued efforts to control and monitor opioid prescriptions and their effectiveness. Two other studies looked at knee surgery in patients with meniscus tears or damage to the cartilage.

Ankle sprains and opioid prescriptions

A Michigan Medicine report published this month in the Annals of Internal Medicine found that the rate of opioid prescriptions for ankle sprains has increased in recent years.

The researchers looked at health insurance claim data for 592,000 patients diagnosed with an ankle sprain over a nine-year period, from 2008 to 2016, and found that 11.9% were prescribed opioids. Of those patients who had not been prescribed opioids in the year before the sprain, 8.4% were still filling the prescription three months after the original diagnosis.

About 25% of patients with ankle sprains received opioid prescriptions in emergency medicine and primary care settings, researchers found.

Opioids are not recommended for ankle sprains, said one of the authors, James R. Holmes, an associate professor of orthopedic surgery at Michigan Medicine. What is recommended is cold therapy, nonsteroidal anti-inflammatory drugs, functional support, and exercise, he said.

“No evidence-based treatment guidelines for ankle sprains include prescribing opioids,” he said in a release.

Opioid use lower in patients given NSAIDS

It is possible to control pain after surgery by giving patients fewer opioids than had previously been prescribed, researchers from the New York University Hospital for Joint Diseases found.

In a small randomized study of 40 patients who had arthroscopic shoulder surgery, the group that received a 10-pill “rescue” prescription of Percocet plus ibuprofen used fewer opioids than a similar group that was prescribed Percocet alone, the researchers found.

The research was presented at the American Orthopedic Society for Sports Medicine’s (AOSSM) annual meeting held earlier this month.

“The public health crisis of opioid abuse requires an immediate solution beginning with the reduction of post-operative narcotics distribution,” said Kamali A. Thompson, one of the researchers.

Two recent studies highlight the treatment for meniscus injuries.
Two recent studies highlight the treatment for meniscus injuries.

Surgery may be better than doing nothing for older patients with meniscus tears

Patients over age 50 who had arthroscopic surgery for meniscus tears had a lower rate of total knee replacement surgery in the two-year follow-up, researchers at Stanford Medicine found.

The research was presented at the AOSSM’s annual meeting held earlier this month.

The patients were diagnosed with a meniscal root tear. The meniscus is the spongy cushion between the top and lower parts of the knee joint. Tears can affect younger healthy athletes and older patients with degenerative knees. There is currently no successful treatment path for older patients.

The study looked at outcomes in 48 cases and found that only 3% of those who had a repair of the meniscal root went on to need a knee replacement compared with 33% in the observational group.

Surgery should be considered for the treatment of meniscal root tears in the older population, said Jason L. Dragoo, an orthopedic surgeon and one of the Stanford Medicine researchers.

Will platelet-rich plasma therapy help lower risk of meniscus repair?

Platelet-rich plasma therapy, which uses a concentration of the patients own platelets to help with healing, has been shown to reduce the risk of a second meniscus failure.

Ohio State University researchers found the use of platelet-rich plasma (PCP) did not protect patients who had surgery for an anterior cruciate ligament (ACL) tear. It was presented at the AOOSM’s annual meeting held earlier this month.

Researchers randomly assigned 550 patients into two groups: one who had meniscus surgery repair with the PCP treatment, and the other that did not receive the PCP treatment. Patients who had a ACL repair at the same time were followed for three years.

Patients who did not get the added PCP had a 17% higher risk of meniscus failure while those who received the therapy had a 14.7% failure rate. The results for patients who had the ACL repair at the same time were likely to have a higher rate of failure, researchers found.