A new study appearing in the Journal of Bone and Joint Surgery (JBJS) links the use of opioid pain relievers (prescription medications such as Percocet, Hydrocodone, OxyContin and Vicodin) to less improvement and higher levels of dissatisfaction following spine surgery. In this study, 326 out of 583 (56 percent) patients reported some degree of opioid use prior to elective lumbar, thoracolumbar or cervical spine surgery.
Patient-reported health status was measured preoperatively, and at three and 12 months following surgery, using a range of established medical tests that measure levels of physical and mental function, depression, distress, back and other pain, disability, somatization (chronic, physical symptoms with no known cause) and treatment results. Among the findings, increased preoperative opioid use was a significant predictor of worse health outcomes at three and 12 months following surgical treatment.
“We have demonstrated that increasing amounts of preoperative opioid consumption may have a harmful effect on patient reported outcomes in those undergoing spinal surgery,” said lead study author Clinton J. Devin, MD, assistant professor of orthopedic surgery and neurosurgery at the Vanderbilt Spine Center. “Our work highlights the importance of careful preoperative counseling with patients on high doses of preoperative opioids, pointing out the potential impact on long term outcome and working toward narcotic reduction prior to undergoing surgery”.
There is no solid evidence that opioids, or narcotics, work better than non-narcotic pain medications in relieving chronic pain from a spine condition. There are a number of serious risks with opioids that need to be considered. Opioids can be habit-forming if the patient isn’t careful. Opioids can also have limited effectiveness if the patient develops a tolerance to the medication over time. And high opioid doses may produce hyperalgesia syndrome where patients experience increased pain sensitivity, even when doses are increased.
For patients with degenerative disc disease, herniated discs, sciatica, pinched nerves or spinal stenosis, surgery leads to greater long-term improvement in pain, functioning, and mobility compared to non-surgical treatment, concludes an eight year follow-up study in Spine. The researchers analyzed data from the Spine Patient Outcomes Research Trial (SPORT), the largest clinical trial of surgery for spinal disorders, and also the first evidence-based study of spine surgery and pain medications. In SPORT, patients with spine conditions underwent surgical or non-surgical treatment, such as pain-relieving medications.
When outcomes were compared for patients who actually underwent surgery versus non-surgical treatment, significant differences were seen. The investigators found that the peak benefits are achieved within six months after surgery and persist through eight years.
The conclusion is that opioid use does not only debilitate patients prior to surgery but after surgery, as well.
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