After knee replacement (TKA), patients who need psychotropic medicines such as anti-anxiety drugs or antidepressants also tend to need opioids longer, a new study found. That is because they report higher pain scores. Treating emotional distress is part of treating pain after knee surgery.
Summary: TKA is major surgery that needs painkillers for a long time afterward. Doctors also often give drugs for anxiety and depression to ease emotional distress. A new study shows that patients who need these drugs are also more likely to need opioids longer. That is because their pain scores are higher.
Knee osteoarthritis is common in the United States and affects millions of people. It can be treated many ways. The cartilage in the knee joint wears down. That causes pain and disability that can badly hurt a person’s quality of life. Everyday tasks like walking, climbing stairs and being active get hard.
Total knee arthroplasty (TKA), also called knee replacement surgery, is a common treatment for severe knee osteoarthritis. The surgeon takes out the damaged parts of the knee and puts in artificial parts. This can greatly ease pain and help you move better. But TKA is usually only advised for patients who did not get better with less invasive care. That care includes physical therapy, weight control and pain management.
TKA is major surgery. But once the joint heals, it brings big relief. In the end, TKA means less need for painkillers, and most people can live without them. Patients usually need opioids for the first three months after surgery. Opioids control pain after surgery very well, but they are not an excellent choice. They slow healing. And though the risk is small, long opioid use after surgery may raise the risk of opioid dependence in some people.
But pain is not the only concern for people who have TKA. Most patients also need care for mental health problems like emotional distress. Total knee arthroplasty (TKA) can also cause real anxiety and depression in some patients. The reasons vary and overlap. Mostly they come from worry about how the surgery will turn out, how recovery will go and whether they can get back to normal life.
Chronic pain from knee arthritis can lead to depression and anxiety. The physical limits that come with the pain can also make people feel hopeless and depressed. So doctors often give anxiety and mood drugs to TKA patients to help with pain and mental health. Many patients also say pain relief is better when they get anxiety drugs or antidepressants along with opioids.
But now some researchers warn against using anti-anxiety drugs or antidepressants too often in TKA patients. New studies show these drugs may lead to longer opioid use in patients. Patients not only used opioids for longer. They even had higher pain scores when these medicines were added to opioids. But this did not seem to change hospital readmissions or emergency room visits.
So adding these drugs to opioids in TKA patients has limited benefits and must be done with great care. Overall, patients on these drugs needed stronger pain control after surgery. This showed up even in patients who took anxiety drugs or antidepressants for other reasons and had no anxiety or depression. Of course, not every patient can be treated without these drugs. Still, the study shows that people with mood disorders are more likely to have long-lasting pain after TKA. They also tend to heal more slowly.
Frequently asked questions
Why am I so emotional after knee replacement?
Knee replacement (TKA) is major surgery, and anxiety and depression are common after it. The worry usually comes from the surgery itself. Will it work? How hard will recovery be? When can you get back to normal life? Chronic arthritis pain before surgery adds to it. The physical limits that pain brings can leave people feeling hopeless and depressed.
How long do you need opioids after knee replacement?
Most patients need opioids for about the first three months after knee replacement. Once the joint heals, TKA brings big relief, and most people end up living without painkillers at all. Opioids control pain after surgery well, but they are not an excellent choice. They slow healing. Long use after surgery also carries a small risk of opioid dependence in some patients.
Do antidepressants or anxiety medicines increase opioid use after knee replacement?
Yes. In the study, knee replacement patients who took anti-anxiety drugs or antidepressants stayed on opioids longer. They also reported higher pain scores than those who did not. The pattern held even in patients who took these drugs for other reasons and had no anxiety or depression. The drugs did not change hospital readmissions or emergency room visits. But these patients needed stronger pain control.
Is knee replacement the first treatment for knee arthritis?
No. Total knee arthroplasty takes out the damaged parts of the knee and puts in artificial parts. It is usually advised only for severe knee arthritis that did not get better with less invasive care. That care includes physical therapy, weight control and pain management. When it is done, it can greatly ease pain and help you move better once the joint heals.
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