Predictors of Prescription Opioid Use 4 Months After Traumatic Musculoskeletal Injury and Corrective Surgery: A Prospective Study

  • Brittany N. Rosenbloom
    Address reprint requests to Brittany N. Rosenbloom, MSc, MA, Calumet College, York University, Room 308, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada.
    Institute of Medical Science, Department of Anesthesia, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

    Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
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  • Colin J.L. McCartney
    Institute of Medical Science, Department of Anesthesia, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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  • Sonya Canzian
    Trauma and Neurosurgery Program, St. Michael's Hospital, Toronto, Ontario, Canada
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  • Hans J. Kreder
    Division of Orthopedics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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  • Joel Katz
    Institute of Medical Science, Department of Anesthesia, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
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      • 35% of patients continue to use opioids 4 months after traumatic injury.
      • Understanding opioid use after traumatic injury requires an evaluation of pain.
      • Pain intensity and coping predict persistent opioid use after traumatic injury.


      The aim of the present study was to examine the incidence and predictors of persistent prescription opioid use 4 months after traumatic injury. Adults who sustained a traumatic musculoskeletal injury were recruited to participate in this observational prospective, longitudinal study within 14 days of injury (T1) and followed for 4 months (T2). Measures included questionnaires on pain, opioid consumption, pain disability, anxiety, depression, and posttraumatic stress symptoms as well as a chart review for injury related information. The sample consisted of 122 patients (66.4% male; mean age = 44.8 years, SD = 17.1), of whom 94.3% (n = 115) were using prescription opioids. At T2, 35.3% (n = 43) patients were using prescription opioids. After controlling for age, sex, injury severity, T1 pain severity, and T2 symptoms of depression, 2 factors emerged as significantly related to T2 prescription opioid use; namely, T2 pain severity (odds ratio = 1.248, 95% confidence interval, 1.071–1.742) and T2 pain self-efficacy (odds ratio = .943, 95% confidence interval, .903–.984). These results suggest that opioid use after traumatic musculoskeletal injury is related to pain severity and how well patients cope specifically with their pain, over and above other psychological factors, such as depression and anxiety.


      This article identifies predictive factors for prescription opioid use after traumatic musculoskeletal injury, namely severe pain and a poor sense of control over the pain. These results highlight the importance of using prospective longitudinal study designs to understand why patients continue to use prescription opioids after major tissue-damaging events.

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