Summary: Knee replacement (TKA) patients who need psychotropics stay on opioids longer and report more pain, a new study shows. Psychotropics here means anxiolytics (anti-anxiety drugs) and antidepressants for emotional distress. TKA is a major surgery that already needs a long stretch of painkillers afterward.
Knee osteoarthritis is common in the United States and affects millions of people. The cartilage in the knee joint wears down. That causes pain and disability. As people age and get heavier, more of them are expected to get it. The pain and lost function can badly hurt a person’s quality of life. Everyday tasks get hard, like walking, climbing stairs, and staying active.
Total knee arthroplasty (TKA), also called knee replacement surgery, is a common fix for severe knee arthritis. The surgeon removes the damaged parts of the knee and puts in artificial parts. This can greatly cut pain and improve movement. But TKA is usually advised only when simpler care has failed. That means things like physical therapy, weight loss, and pain care.
TKA is major surgery. But once the joint heals, it gives the patient real relief. In the end, TKA lowers the need for painkillers. Most people can live without them.
Most patients need opioids for the first three months after surgery. Opioids control pain after surgery very well, but they are not a great choice. They slow healing. There is also a small but real risk that long opioid use after surgery leads to opioid dependence in some people.
But pain is not the only concern for people who have TKA. Most patients also need treatment for emotional distress. Total knee arthroplasty (TKA) can also cause real anxiety and depression in some patients. The reasons vary and overlap. Most come from worry about how the surgery will turn out, how recovery will go, and whether normal activities will come back.
Chronic pain, a common symptom of knee arthritis, can lead to depression and anxiety. The physical limits that come with a bad knee can also feed hopelessness and depression. So doctors often use psychotropics in TKA patients to manage pain and mental health. Many patients also say pain relief is better when they get these mood drugs along with opioids.
But now some researchers warn against using these mood drugs as a routine in TKA patients. New studies show these drugs may lead to longer opioid use in patients. Patients not only used opioids longer, they also had higher pain scores when psychotropics were added to opioids. But it did not seem to change hospital readmissions or emergency department visits.
So adding psychotropics to opioids in TKA patients has limited benefit and must be done with great care. Overall, patients on these drugs needed stronger pain control after surgery. These problems showed up even in patients who took these drugs 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 and to recover more slowly.
Frequently asked questions
How long will I need pain medication after total knee replacement?
Most patients need opioids for about the first three months after knee replacement. Once the joint heals, the surgery usually lowers the need for painkillers. Most people go on to live without them. Patients who also take mood drugs tend to stay on opioids longer. So plan pain control with your surgeon and pain physician before the operation.
Do antidepressants or anti-anxiety drugs increase opioid use after knee replacement?
In the study this article covers, yes. Knee replacement patients on these mood drugs used opioids longer. They also reported more pain. The effect showed up 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 department visits.
Why do people get depressed or anxious after knee replacement?
Worry drives much of it. People worry about how the surgery will turn out, how long recovery will take, and whether normal activities will come back. Years of knee arthritis pain also feed depression and anxiety. The physical limits of a bad knee add to hopelessness. That is why doctors often prescribe psychotropics around the time of surgery.
Are opioids a good choice for pain after knee replacement?
Opioids control pain after surgery very well, but they are not an ideal choice. They slow healing. Long use after surgery carries a small but real risk of opioid dependence. Patients with mood disorders are more likely to have long-lasting pain and a slower recovery. That makes a careful pain plan even more important for them.
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The content provided herein is not intended to provide assessment, diagnosis, treatment, or medical advice; it also does not constitute provision of healthcare services. No information in this content should ever be considered as a substitute for advice from a healthcare professional, it is provided for thoughtful discussion, informational and educational purposes only.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
