Factors Affecting Long-Term Postoperative Narcotic Use in Discectomy Patients

Qureshi, Rabia; Werner, Brian C.; Puvanesarajah, Varun; Horowitz, Jason A.; Jain, Amit; Sciubba, Daniel M.; Shen, Francis H.; Hassanzadeh, Hamid

doi:10.1016/j.wneu.2018.01.113

Cited by 25 publications

(17 citation statements)

References 62 publications

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“…However, the length of time required for LTOT does not always account for consistent opioid therapy during follow‐up. The definitions of opioid therapy during the time windows within the follow‐up time were not strict and many definitions only required one opioid prescription during a predefined time period for LTOT . For example, one study defined LTOT as at least one prescription 305 to 425 days after a hospital discharge …”

Section: Discussionmentioning

confidence: 99%

Long‐term opioid therapy definitions and predictors: A systematic review

Karmali

Bush

Raman

et al. 2019

Pharmacoepidemiology and Drug

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Purpose This review sought to (a) describe definitions of long‐term opioid therapy (LTOT) outcome measures, and (b) identify the predictors associated with the transition from short‐term opioid use to LTOT for opioid‐naïve individuals. Methods We conducted a systematic review of the peer‐reviewed literature (January 2007 to July 2018). We included studies examining opioid use for more than 30 days. We classified operationalization of LTOT based on criteria used in the definitions. We extracted LTOT predictors from multivariate models in studies of opioid‐naïve individuals. Results The search retrieved 5,221 studies, and 34 studies were included. We extracted 41 unique variations of LTOT definitions. About 36% of definitions required a cumulative duration of opioid use of 3 months. Only 17% of definitions considered consecutive observation periods, 27% used days' supply, and no definitions considered dose. We extracted 76 unique predictors of LTOT from seven studies of opioid‐naïve patients. Common predictors included pre‐existing comorbidities (21.1%), non‐opioid prescription medication use (13.2%), substance use disorders (10.5%), and mental health disorders (10.5%). Conclusions Most LTOT definitions aligned with the chronic pain definition (pain more than 3 months), and used cumulative duration of opioid use as a criterion, although most did not account for consistent use. Definitions were varied and rarely accounted for prescription characteristics, such as days' supply. Predictors of LTOT were similar to known risk factors of opioid abuse, misuse, and overdose. As LTOT becomes a central component of quality improvement efforts, researchers should incorporate criteria to identify consistent opioid use to build the evidence for safe and appropriate use of prescription opioids.

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Section: Discussionmentioning

confidence: 99%

Long‐term opioid therapy definitions and predictors: A systematic review

Karmali

Bush

Raman

et al. 2019

Pharmacoepidemiology and Drug

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“…Smoking was also associated with chronic postoperative pain in patients treated with hysterectomy [ 81 ], total shoulder arthroplasty [ 82 ], and nonunion surgery [ 83 ]. Moreover, smoking was associated with opioid analgesic use for ≥ 3 months postoperatively in various orthopedic surgeries, including hip replacement [ 84 ], shoulder arthroplasty [ 82 , 85 ], and spine surgeries [ 86 , 87 ], as well as in cardiothoracic [ 88 ], urologic [ 89 ], and kidney donation surgeries [ 90 ]. Smoking is a significant predictor of opioid abuse [ 91 , 92 ].…”

Section: Clinical Questionsmentioning

confidence: 99%

“…In a study of chronic pain medication use, smokers showed poor pain medication adherence, and overuse was associated with current smoking [ 110 ]. Smokers had a greater likelihood of long-term opioid use after major surgeries [ 86 , 111 ].…”

Section: Clinical Questionsmentioning

confidence: 99%

Consensus statement on smoking cessation in patients with pain

et al. 2022

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Smoking is closely associated with the development of various cancers and tobacco-related illnesses such as cardiovascular and respiratory disorders. However, data are scarce on the relationship between smoking and both acute and chronic pain. In addition to nicotine, tobacco smoke contains more than 4000 different compounds. Although nicotine is not the sole cause of smoking-induced diseases, it plays a critical role in pain-related pathophysiology. Despite the acute analgesic effects of nicotine, long-term exposure leads to tolerance and increased pain sensitivity due to nicotinic acetylcholine receptor desensitization and neuronal plastic changes. The purpose of smoking cessation interventions in smoking patients with pain is primarily not only to reduce their pain and associated limitations in activities of daily living, but also to improve the outcomes of underlying pain-causing conditions and reduce the risks of tobacco-related disorders. This statement aims to summarize the available evidence on the impact of smoking on pain and to inform medical professionals of the significance of smoking cessation in patients with pain.

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“…[ 13 ] In a prospective study of 277 patients undergoing lumbar spinal surgery for radicular syndrome, den Boer et al noted that cognitive-behavioral factors independently contributed to disability and pain intensity. [ 9 ] Recent studies by Qureshi et al [ 16 , 17 ] identified depression and a study by Schoenfeld et al [ 18 ] identified depression and anxiety as psychiatric risk factors leading to prolonged opioid use after lumbar spine surgery.…”

Section: Discussionmentioning

confidence: 99%

Review of psychiatric comorbidities and their associations with opioid use in elective lumbar spine surgery

Mezzacappa¹,

Schmidt²,

Tenny³

et al. 2020

Medicine

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The opioid epidemic is an ongoing concern in the United States and efforts to ameliorate this crisis are underway on multiple fronts. Opiate use is an important consideration for patients undergoing lumbar spine surgery with concurrent psychiatric diagnoses and more information is needed regarding the factors involved in these patients. That information may help guide opioid prescribing practices for individual patients with certain psychiatric conditions that are undergoing these procedures. This study was done to identify psychiatric conditions that are associated with preoperative and postoperative opioid use in this cohort of veteran patients undergoing elective lumbar spine surgery. A 3 month preoperative and 3 month postoperative chart review was conducted on 25 patients per year who underwent elective lumbar spine surgery over a 16-year period at the Veterans Affairs Nebraska-Western Iowa Healthcare Center (n = 376 after exclusion criteria applied). The association between psychiatric comorbidities and use of opioids during the 90-day period after surgery was assessed using a linear model that adjusted for surgical type, opioid use prior to surgery, and other relevant comorbidities. Patients are more likely to use opioids preoperatively if they have major depression (P = .02), hepatitis C (P = .01), or musculoskeletal disorders (P = .04). PTSD (P = .02) and lumbar fusion surgery (P < .0001) are associated with increased postoperative use, after adjusting for preoperative use and other comorbidities. Certain psychiatric comorbidities are significantly correlated with opioid use for this cohort of lumbar spine surgery patients in the preoperative and postoperative periods. Awareness of an individual's psychiatric comorbidity burden may help guide opioid prescription use.

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Factors Affecting Long-Term Postoperative Narcotic Use in Discectomy Patients

Cited by 25 publications

References 62 publications

Long‐term opioid therapy definitions and predictors: A systematic review

Long‐term opioid therapy definitions and predictors: A systematic review

Consensus statement on smoking cessation in patients with pain

Review of psychiatric comorbidities and their associations with opioid use in elective lumbar spine surgery

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