Use of prescription opioids before and after an operation for chronic pain (lumbar fusion surgery)

Abstract

Lumbar fusion surgery is usually prompted by chronic back pain, and many patients receive long-term preoperative opioid analgesics. Many expect surgery to eliminate the need for opioids. We sought to determine what fraction of long-term preoperative opioid users discontinue or reduce dosage postoperatively; what fraction of patients with little preoperative use initiate long-term use; and what predicts long-term postoperative use. This retrospective cohort study included 2491 adults undergoing lumbar fusion surgery for degenerative conditions, using Oregon's prescription drug monitoring program to quantify opioid use before and after hospitalization. We defined long-term postoperative use as ≥4 prescriptions filled in the 7 months after hospitalization, with at least 3 occurring >30 days after hospitalization. Overall, 1045 patients received long-term opioids preoperatively, and 1094 postoperatively. Among long-term preoperative users, 77.1% continued long-term postoperative use, and 13.8% had episodic use. Only 9.1% discontinued or had short-term postoperative use. Among preoperative users, 34.4% received a lower dose postoperatively, but 44.8% received a higher long-term dose. Among patients with no preoperative opioids, 12.8% became long-term users. In multivariable models, the strongest predictor of long-term postoperative use was cumulative preoperative opioid dose (odds ratio of 15.47 [95% confidence interval 8.53-28.06] in the highest quartile). Cumulative dose and number of opioid prescribers in the 30-day postoperative period were also associated with long-term use. Thus, lumbar fusion surgery infrequently eliminated long-term opioid use. Opioid-naive patients had a substantial risk of initiating long-term use. Patients should have realistic expectations regarding opioid use after lumbar fusion surgery.

Interspinous process decompression is associated with a reduction in opioid analgesia in patients with lumbar spinal stenosis

“…Indeed, prior to lumbar fusion surgery, over 90% of patients surveyed considered continued dependence on opioids neither an expected nor acceptable outcome. 34 In a retrospective cohort study of 2,492 patients having lumbar fusion surgery for degenerative conditions, including LSS, Deyo et al 35 found that more patients received long-term opioids postoperatively (n=1,094) than preoperatively (n=1,045). Additionally, opioid-naïve patients had a substantial risk of initiating long-term use.…”

Misperceptions about the ‘Opioid Epidemic:’ Exploring the Facts

“…Preoperative opioid use was found to be the strongest predictive factor in some studies, with 71%-77% of preoperative opioid users continuing at 6-7 months postoperatively (Bartels, Fernandez-Bustamante, McWilliams, Hopfer, & Mikulich-Gilbertson, 2018;Deyo et al, 2018;Rozet et al, 2014). Further, surgery itself may result in or worsen chronic pain for some patients.…”

“…Further, surgery itself may result in or worsen chronic pain for some patients. Deyo et al (2018) found that lumbar fusion surgery infrequently eliminated the use of long-term opioids, with 44.8% of preoperative opioid users requiring higher dose postoperatively. Among opioid-naive preoperative patients, 12.8% became long-term opioid users after lumbar fusion.…”

The Risk of Prior Opioid Exposure on Future Opioid Use and Comorbidities in Individuals With Non-Acute Musculoskeletal Knee Pain

“… 16 The predictive value of prior opioid use on future opioid use is well established in surgical cohorts. 9 , 17 - 19 Work has also been done to identify rates and predictors of opioid use for many conditions including musculoskeletal pain in non-surgical primary care settings. 20 However, outside of low back pain, 21 we have not found any investigation into the predictive value of prior opioid use for future opioid use in non-surgical and non-cancer pain cohorts.…”