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 More than 77 percent continued long-term postoperative use, and 14
percent had occasional use, the study authors wrote in the journal
PAIN.
“The important message here is that patients go into surgery
thinking it will eliminate their need to take pain medication. But
for this type of surgery, it’s unlikely that patients will end up
stopping opioids,” lead author Dr. Richard Deyo of Oregon Health and
Science University in Portland told Reuters Health by phone.
According to the American Academy of Orthopedic Surgeons, spinal
fusion “(corrects) problems with the small bones of the spine
(vertebrae). It is essentially a ‘welding’ process. The basic idea
is to fuse together the painful vertebrae so that they heal into a
single, solid bone.”
Deyo and colleagues studied nearly 2,500 adults who underwent lumbar
spine (lower back) fusion surgery in Oregon, using the state’s
prescription drug monitoring program to quantify opioid use before
and after the surgery. They defined long-term postoperative use as
more than four prescriptions filled in the seven months following
the surgery, with at least three prescriptions filled more than 30
days after the surgery.
They found that 1,045 patients received long-term opioids before
surgery and 1,094 received them after surgery. Among the long-term
users, 77 percent continued long-term use and 14 percent had
episodic use. About 9 percent discontinued using opioids or only
used them shortly after surgery.
“The chronic pain story is a complicated one, and there is growing
evidence that opioids aren’t necessarily better than non-opioid
options for pain,” Deyo said. “We should redouble our efforts to
treat patients with long-term back problems with medications other
than opioids so they can avoid them in the long run.”
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Importantly, among those who had opioid prescriptions before
surgery, 34 percent received a lower dose after surgery, but 45
percent received a higher dose. In addition, among those with no
opioid prescriptions before surgery, 13 percent became long-term
users after surgery.
As part of the analysis, Deyo and colleagues found that the
prescription dose before surgery was the strongest predictor of
long-term use after surgery.
“It’s not fair to say that continued use represents failure of the
surgery, but instead, it represents poor transitions of care and a
failure to coordinate care for patients,” said Dr. Chad Brummett of
the University of Michigan Medical School, who was not involved in
the study.
Brummett and colleagues launched the Michigan Opioid Prescribing
Engagement Network in 2016 to develop a preventive approach to the
opioid epidemic in the state. They plan to tailor opioid
prescriptions in the post-surgery and acute care settings.
“For those using opioids and seeking surgery to cure the pain, it’s
critical to work with your doctor to wean you down, both before and
after surgery,” Brummett told Reuters Health by phone.
SOURCE: http://bit.ly/2pKd3bK PAIN, online March 6, 2018.
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