A study published in SPINE in September 2017 examined risk factors for long-term opioid use following lumbar spinal fusion surgery in a nationally representative cohort of commercially insured adults.
Using one of the nation’s largest commercial insurance databases, study authors conducted a retrospective cohort study of 8,377 adults, aged 21 to 63 years, who underwent lumbar spinal fusion surgery between January 1, 2009, and December 31, 2012. Long-term opioid use was defined as greater than or equal to 365 days of filled opioid prescriptions in the 24 months following lumbar fusion.
Study Results
Overall, approximately 30% of fusion patients used long-term opioids post-operatively.
The strongest predictor of long-term post-operative narcotic use was duration of pre-operative narcotic use. Compared to patients who had not received prescriptions for opioids pre-operatively, those who had received 1-22 days of pre-operative opioids had over twice the odds of long-term use (5% vs. 2%), and those who had taken opioids for over 250 days pre-operatively had an odds ratio of 220 relative to the opioid naïve patients (84% vs. 2%).
There was a clear dose-response curve, with increasing duration of pre-operative use associated with increasing risk of long-term post-operative use. Depression and undergoing a revision fusion operation increased the risk of long-term use modestly, while those undergoing anterior fusion were 21% less likely to use opioids in the long-term compared to those undergoing posterior fusion.
The results of this study come as no surprise to practicing spine surgeons and are consistent with the literature. It is rare for a patient who has been on long-term opioids pre-operatively to come off of these medications after fusion surgery. The fact that only 2% of the opioid naïve patients and 5% of those on narcotics for under 3 weeks pre-operatively went onto long-term use is reassuring and suggests that spine surgery itself is a relatively uncommon route for patients to develop problems with opioid dependence. This paper suggests that long-term treatment with opioids pre-operatively is the main driver of long-term opioid use post-operatively, so efforts to avoid treating low back pain with narcotics are essential to addressing this problem.
Find Pain Relief – Without Fusions or Opioids
There are many factors to consider if you have been recommended a fusion surgery. There are also many cases in which the outpatient Bonati Spine Procedures can provide a less invasive and more targeted alternative to fusion. If you’re seeking treatment for chronic neck or back pain, allow our surgeons to review your case before making any final decisions. Over 70,000 patented Bonati Spine Procedures have been performed with a 98.75% patient reported satisfaction rating. To get your review process started, call 855-267-0482 or complete our MRI review form.
To access the full study and abstract, visit Spine here: https://journals.lww.com/spinejournal/Abstract/2017/09150/Predictors_of_Long_term_Opioid_Use_Following.12.aspx. Find the Spine blog about the study here: https://journals.lww.com/spinejournal/blog/SpineBlog/pages/post.aspx?PostID=505