Opioid Reduction Following Interventional Procedures for Chronic Pain: A Synthesis of the Evidence

Abstract

The past decade has witnessed the tremendous growth of procedures to treat chronic pain, which has resulted in increased third-party scrutiny. Although most of these procedures appear to be associated with significant pain relief, at least in the short and intermediate term, their ability to improve secondary outcome measures, including function and work status is less clear-cut. One of these secondary outcome measures that has garnered substantial interest in the pain and general medical communities is whether interventions can reduce opioid intake, which is associated with significant risks that in most cases outweigh the benefits in the long term. In the article, we examine whether procedural interventions for chronic pain can reduce opioid intake. Most studies that have examined analgesic reduction as a secondary outcome measure have not separated opioid and nonopioid analgesics, and, among those studies that have, few have demonstrated between-group differences. Reasons for failure to demonstrate opioid reduction can be broadly classified into procedural, design-related, clinical, psychosocial, biological, and pharmacological categories, all of which are discussed. In the future, clinical trials in which this outcome is examined should be designed to evaluate this, at least on a preliminary basis.

Opioid Fills for Lumbar Facet Radiofrequency Ablation Associated with New Persistent Opioid Use

“…5,[7][8][9] To date, chronic postintervention opioid use has largely been used as a secondary outcome and a surrogate of treatment failure. [10][11][12][13][14][15] Given the frequency with which interventional procedures are utilized for facet joint-mediated pain syndromes, it is worth evaluating the impact of periprocedural opioid prescribing on the risk of chronic opioid use in the setting of lumbar radiofrequency ablation. Our primary goal was to determine the incidence of new persistent opioid use after radiofrequency ablation of the medial branches for facet-mediated low back pain.…”

The opioid epidemic: How did we get here and where do we stand?

“…15,16 As mentioned above, chronic pain can be modulated by several comorbidities, including depression, smoking and anxiety. 13,14 For individuals with a history of these conditions, Hah et al suggest that these patients may benefit from preoperative and ongoing postoperative cognitive behavioural therapy (CBT) in order to help curtail the risk of opioid abuse and misuse. 6 Furthermore, Vetter et al suggests the implementation of a Transitional Pain Service (TPS), where applicable.…”

“…Chronic pain can be altered by several comorbid factors including depression, anxiety, poor coping skills, personality, sleep, and concurrent substance use disorders. 13,14 The presence of chronic pain may exacerbate a patient's psychiatric, functional, and social difficulties, all of which can act to influence their opioid use. The importance of this cannot be understated as it demonstrates that chronic pain may best be treated using a multimodal approach in contrast to increasing opioid dosages.…”

“…The importance of this cannot be understated as it demonstrates that chronic pain may best be treated using a multimodal approach in contrast to increasing opioid dosages. 13,14 Addressing the Opioid Crisis…”