Women are twice as likely as men to take pain medication over a 12-week, post-discharge period, according to researchers.
The secondary analysis of a large study identified factors that influence postoperative pain medicine use in orthopedic trauma patients who also received a psychosocial intervention or standard trauma intervention. The analysis found no significant difference in pain medicine use at week 12 between the two groups.
The study, presented at the 2017 annual meeting of the American Academy of Physical Medicine and Rehabilitation (poster 29), also found that post-traumatic stress disorder (PTSD) disproportionately affects women after orthopedic trauma and suggests that PTSD coping strategies could help reduce follow-up medication.
Heather Vincent, PhD, FACSM, author of the study and the director of the University of Florida Sports Performance Center, in Gainesville, speculated that women may cope with injury differently from men. “Women may be caring for children or parents. They may be a single parent or have multiple other sources of stress. The thought of the injury may trigger PTSD symptoms that may make them feel overwhelmed,” she explained.
“Sex is usually confounded with measured or unmeasured factors, such as culture, stress, distress and coping strategies,” said David Ring, MD, PhD, the associate dean for comprehensive care, Dell Medical School at the University of Texas, in Austin. “It seems like sex is associated with taking more pain medication, but it might be a third factor, such as stress that is actually causing the association.
“Recovery from injury is emotional and stressful. Symptoms of depression and post-traumatic stress are common. Catastrophic thinking … is also common and hinders recovery,” Dr. Ring said.
He also cautioned against overstating the results of this secondary analysis. “Although this study did not demonstrate a positive influence from a psychosocial intervention, many if not most other studies did show improvement,” Dr. Ring said. “It’s notable that more than half of these patients were still taking opioids three months after injury. That is, to be frank, inappropriate. Opioids are for acute pain and should be used for as brief a time as possible in the smallest possible dose.”
“It’s unclear if there was a difference in the types of trauma between men and women,” said Steven P. Stanos, DO, the president of the American Academy of Pain Medicine. “Did women have greater pretraumatic levels of anxiety and PTSD that impacted subsequent traumas and response to treatment? Gender differences in patients reporting affective distress, including signs and symptoms of post-traumatic stress disorder, deserve further study.”
Dr. Vincent called PTSD among women “an interesting and unanticipated outcome,” and said she is collecting more data on trauma patients to help determine links between PTSD and a patient’s characteristics or life events. In the meantime, she advised providers to perform a PTSD checklist assessment for initial symptoms.
“Acknowledging the difficult recovery and simply asking whether they would like to talk to someone about what they are feeling is important to validate the patient’s feelings,” Dr. Vincent said. “Refilling pain medication prescriptions at follow-ups without addressing patient emotional challenges perpetuates the problem and alienates the patient. Connecting with clinical psychology may be very useful for these patients to help them empower themselves rather than depending on pain medicine.”