The influence of prior opioid use on healthcare utilization and recurrence rates for non-surgical patients seeking initial care for patellofemoral pain



Prior opioid use can influence outcomes for patients with musculoskeletal disorders. The purpose of this study was to compare downstream medical utilization-based outcomes (costs, visits, recurrent episodes) after an initial diagnosis of patellofemoral pain based on pre-injury utilization of opioids.


A total of 85,7880 consecutive patients were followed for a full 12 months before and 24 months after an initial diagnosis of patellofemoral pain (January 2009 to December 2013). Data were sourced from the Military Health System Data Repository, a single-payer closed government system. Opioid prescription fills were identified, and medical visits and costs were calculated for all knee-related medical care, to include recurrence rates in the 2-year surveillance period.


A relatively small number of individuals filled an opioid prescription in the year prior (n = 1746; 2.0%); however, these individuals had almost twice the mean costs of knee-related medical care ($1557 versus %802) and medical visits (8.4 versus 4.0). Patients with prior opioid use were more likely to have at least 1 recurrent episode of knee pain (relative risk 1.58, 95% CI 1.51, 1.65) with a higher mean number of episodes of knee pain (1.5 vs 1.8). The use of opioids with higher risk of misuse or dependency (Schedule II or III) resulted in greater medical costs (for any reason) and recurrent episodes of knee pain compared to the use of opioids in a lower risk category (Schedule IV).


Prior opioid utilization was associated with a greater number of recurrent episodes of knee pain and higher downstream medical costs compared with individuals without prior opioid use. For individuals with prior opioid utilization, opioids with higher risk of misuse or dependency (Schedule II or III) resulted in greater medical costs (for any reason) and recurrent episodes compared to the use of lower-risk opioids (Schedule IV).

Key Points
Patients with prior opioid use had much greater knee-related medical costs compared to patients without prior opioid use.
Patients with prior opioid use were more likely to have additional episodes of knee pain in the following 2 years compared to patients without prior opioid use.
Prior opioid use has predicted higher costs and poor outcomes after surgery, but this is the first study to confirm similar findings in non-surgical patients.

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Fig. 1

Data availability

Data is proprietary to the US Defense Health Agency. It can be requested after the approval of a Data Sharing Agreement Application available at


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Author information




DR conceived the idea, procured the data, and ran the primary analyses. CC and SS reviewed and confirmed the analyses. All the authors participated in the synthesis of results, manuscript preparation, revisions, and approval of the final copy.

Corresponding author

Correspondence to Daniel I. Rhon.

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The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Air Force, the Department of the Army, the Defense Health Agency, the Department of Defense or the U.S. Government.



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The study was approved by the Institutional Review Board at Army Regional Health Command Central.

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Consent requirements were waived by the IRB due to the nature of this study.

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Rhon, D.I., Cook, C.E., Cleland, J.A. et al. The influence of prior opioid use on healthcare utilization and recurrence rates for non-surgical patients seeking initial care for patellofemoral pain. Clin Rheumatol 40, 1047–1054 (2021).

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  • Health services
  • Knee
  • Musculoskeletal pain
  • Opioids
  • Patellofemoral