Opioid Use in Adults With Low Back or Lower Extremity Pain Who Undergo Spine Surgical Treatment Within 1 Year of Diagnosis

Abstract

Study Design. Retrospective longitudinal cohort. Objective. We investigated opioid prescribing patterns amongst adults in the United States diagnosed with low back or lower extremity pain (LBP/LEP) who underwent spine surgery. Summary of Background Data. Opioid-based treatment of LBP/LEP and postsurgical pain has separately been associated with chronic opioid use, but a combined and large-scale cohort study is missing. Methods. This study utilizes commercial inpatient, outpatient, and pharmaceutical insurance claims. Between 2008 and 2015, patients without previous prescription opioids with a new diagnosis of LBP/LEP who underwent surgery within 1 year after diagnosis were enrolled. Opioid prescribing patterns after LBP/LEP diagnosis and after surgery were evaluated. All patients had 1-year postoperative follow-up. Low and high frequency (6 or more refills in 12 months) opioid prescription groups were identified. Results. A total of 25,506 patients without previous prescription opioids were diagnosed with LBP/LEP and underwent surgery within 1 year of diagnosis. After LBP/LEP diagnosis, 18,219 (71.4%) were prescribed opioids, whereas 7287 (28.6%) were not. After surgery, 2952 (11.6%) were prescribed opioids with high frequency and 22,554 (88.4%) with low frequency. Among patients prescribed opioids before surgery, those with high-frequency prescriptions were more likely to continue this pattern postoperatively than those with low frequency prescriptions preoperatively (OR 2.15, 95% CI 1.97–2.34). For those prescribed opioids preoperatively, average daily morphine milligram equivalent (MME) decreased after surgery (by 2.62 in decompression alone cohort and 0.25 in arthrodesis cohort, P < 0.001). Postoperative low-frequency patients were more likely than high-frequency patients to discontinue opioids one-year after surgery (OR 3.78, 95% CI 3.59–3.99). Postoperative high-frequency patients incurred higher cost than low-frequency patients. Postoperative high-frequency prescribing varied widely across states (4.3%–20%). Conclusion. A stepwise association exists between opioid use after LEP or LBP diagnosis and frequency and duration of opioid prescriptions after surgery. Simultaneously, the strength of prescriptions as measured by MME decreased following surgery. Level of Evidence: 3

Postoperative Pain Management Following Orthopedic Spine Procedures and Consequent Acute Opioid Poisoning: An Analysis of New York State From 2009 to 2018

“…Although several studies have previously examined the rate of opioid poisonings among demographic groups within the SPARCS database, 15,16 this study is one of the first to examine opioid poisonings within a procedure-type cohort of SPARCS patients and additionally examine SPARCS data in the context of state legislation. Given previous literature reporting high opioid use among spine patients, 17,18 we examined the rate of acute opioid poisoning in the 10 primary orthopedic spine procedures that yielded the highest frequency of postoperative ED visits for opioid poisoning (Supplemental Table 2, Supplemental Digital Content 1, http://links.lww.com/BRS/B868). Between 2009 and 2018, 107,456 adult New York residents underwent these 10 procedures and of this group, 321 (0.3%) presented to the ED with acute opioid poisoning.…”

More Than 1 in 3 Patients With Chronic Low Back Pain Continue to Use Opioids Long-term After Spinal Fusion

“…Prior opioid use is one of the strongest predictors for long-term postoperative opioid use. 13,[35][36][37][38] Tracking preoperative opioid use in clinical studies would allow its assessment as an effect modifier, improving what can be known about treatment outcomes. If an important goal of surgery is to reduce dependency on opioids, tracking and reporting opioid use both before and after surgery is necessary.…”

“…However, this study excluded from the analysis anyone with opioid use in the previous 6 months. 83 Because 41.9%-71.4% of patients undergoing fusion have used opioids previously, 13,38 this would likely confound the results found by Schoenfeld et al 83 and limits the generalizability across individuals most likely to undergo this procedure.…”

Health Care Resource Utilization in Management of Opioid-Naive Patients With Newly Diagnosed Neck Pain

“…Data used in this study were derived from the IBM Watson Health MarketScan Database, a nationally sourced administrative claims database spanning 2007 to 2016 and encompassing more than 75 million enrollees covered by eligible health care plans that has been used to explore diverse spinal pathologies. [22][23][24] This study was approved by the Stanford University School of Medicine institutional excluded. Those with a documented opioid prescription during the year before the index diagnosis date were excluded to differentiate acute neck pain from chronic pain syndromes.…”