Predictors of Postoperative Pain and Narcotic Use After Primary Arthroscopic Rotator Cuff Repair

To determine specific patient characteristics that might be predictive of pain and narcotic use after primary arthroscopic rotator cuff repair, repairs performed by a single surgeon over a 4-year period were identified. Patient-specific preoperative factors investigated included tobacco use, narcotic use, chronic pain syndromes, disability claims, mood disorders (depression/anxiety), workers’ compensation claims, and obesity. Outcome measures included visual analog pain scores and narcotic usage. For the 65 repairs in the study, significant predictors of increased pain scores at 12 weeks were preoperative narcotic use, chronic pain syndromes, and mood disorders. Tobacco use, obesity, and workers’ compensation claims were not associated with higher pain scores. Cumulative narcotic usage at 12 weeks was significantly higher in patients with tobacco use, preoperative narcotic use, and mood disorders. There was no statistically significant increase in narcotic usage in chronic pain syndromes, workers’ compensation claims, or obesity. Preoperative narcotic use and mood disorders were most predictive of increased pain and narcotic usage after primary arthroscopic rotator cuff repair. Tobacco use was associated with significantly higher postoperative narcotic use but no statistically significant increase in pain scores. Chronic pain syndromes were associated with significantly higher pain scores but not significant increases in postoperative narcotic use. Patients with preoperative risk factors including tobacco use, narcotic use, and mood disorders should be counseled about potential increased postoperative perception of pain after arthroscopic rotator cuff repair, and surgeons should be prepared to offer alternative pain management strategies in these patients.