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Spinal surgery may not cut need for painkillers

(Reuters Health) - Most patients who take prescription opioids for chronic pain before lumbar fusion surgery continue taking them long-term after surgery, a new study suggests.

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.”

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: PAIN, online March 6, 2018.