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

Richard (Rick) Deyo, Sara E. Hallvik, Christi Hildebran, Miguel Marino, Nicole O'Kane, Jody Carson, Joshua Van Otterloo, Dagan A. Wright, Lisa M. Millet, Wayne Wakelan

Research output: Contribution to journalArticle

10 Citations (Scopus)

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 longterm 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.

Original languageEnglish (US)
Pages (from-to)1147-1154
Number of pages8
JournalPain
Volume159
Issue number6
DOIs
StatePublished - Jan 1 2018

Fingerprint

Chronic Pain
Opioid Analgesics
Prescriptions
Hospitalization
Prescription Drugs
Drug Monitoring
Back Pain
Postoperative Period
Cohort Studies
Retrospective Studies
Odds Ratio
Confidence Intervals

Keywords

  • Chronic pain
  • Opioids
  • Spinal fusion
  • Spine surgery

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Use of prescription opioids before and after an operation for chronic pain (lumbar fusion surgery). / Deyo, Richard (Rick); Hallvik, Sara E.; Hildebran, Christi; Marino, Miguel; O'Kane, Nicole; Carson, Jody; Van Otterloo, Joshua; Wright, Dagan A.; Millet, Lisa M.; Wakelan, Wayne.

In: Pain, Vol. 159, No. 6, 01.01.2018, p. 1147-1154.

Research output: Contribution to journalArticle

Deyo, RR, Hallvik, SE, Hildebran, C, Marino, M, O'Kane, N, Carson, J, Van Otterloo, J, Wright, DA, Millet, LM & Wakelan, W 2018, 'Use of prescription opioids before and after an operation for chronic pain (lumbar fusion surgery)', Pain, vol. 159, no. 6, pp. 1147-1154. https://doi.org/10.1097/j.pain.0000000000001202
Deyo, Richard (Rick) ; Hallvik, Sara E. ; Hildebran, Christi ; Marino, Miguel ; O'Kane, Nicole ; Carson, Jody ; Van Otterloo, Joshua ; Wright, Dagan A. ; Millet, Lisa M. ; Wakelan, Wayne. / Use of prescription opioids before and after an operation for chronic pain (lumbar fusion surgery). In: Pain. 2018 ; Vol. 159, No. 6. pp. 1147-1154.
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