By Neel Anand, M.D., Contributor – Aug. 6, 2018
AS THE AMERICAN legislature and medical community continue efforts to stem the tide of the growing opioid crisis in our country, researchers are working diligently to highlight what a dangerous path doctors may be putting patients on when writing prescriptions for opioid medications to address chronic back pain as a result of a spinal condition. A new study published in the Journal of Bone & Joint Surgery indicates that the duration of pre-operative opioid usage was the strongest predictor of continued use after surgery. Other studies also paint an upsetting picture of spine surgery outcomes in patients who engaged in prolonged opioid use before surgery.
Opioid usage is on a steady rise in the United States over the last few decades, particularly among people who are affected by spinal conditions that result in severe or chronic back pain. Researchers have estimated that up to half of the people who undergo spine surgery are taking opioid medications at the time of surgery, with 20 percent possibly addicted to these medications. This is an essential topic for the medical community to pay significant attention to so we can help reduce patients’ dependence on and misuse of powerful opioid narcotics that aren’t intended for long-term usage.
The recent Journal of Bone & Joint Surgery study indicates that people who took prescription opioid medications for six months or longer before undergoing lumbar spine surgery were more likely to continue opioid usage after surgery. Nearly all of the patients studied had some exposure to opioid medications before surgery, and they were classified into four categories: exposed, acute exposed, intermediate sustained use and chronic sustained use.
The primary risk factor for continued opioid usage after surgery was the duration of opioid usage pre-surgery. The study authors referred to a “dose-response” effect, finding that patients who took opioids for six months or longer before surgery were 65 to 74 percent less likely to stop using them after surgery than the other study subjects who had not had as much exposure to opioid medications before surgery. The good news from the study indicated that most of the patients using prescription opioids before surgery stopped using them after surgery.