On SAGE Insight: What are the potential risk factors for continued opioid use in patients being treated for low back pain?

Article title: Risk Factors for Continued Opioid Use in Conservative Versus Surgical Management of Low Back Pain Originating From the Sacroiliac Joint

From Global Spine Journal

Lower back pain is the most common reason for opioid prescription in the United States and a significant risk factor for ensuing opioid abuse. Causing more deaths than any other routine medical treatment of nonfatal conditions, prescription opioid use has become a national epidemic in the United States. Opioid prescription for LBP is especially controversial since current evidence suggests no clear-cut long-term benefits versus placebo. Risk factors for continued opioid use are rarely reported and predominantly derived from patient cohorts undergoing a specific surgical intervention without comparison to a similar patient cohort undergoing conservative management (CM).

The objective of this study was to identify risk factors for continued opioid use after conservative management (CM) or minimally invasive surgical management. The specific goal was to describe the prevalence and dosage of opioid use over time and to test the hypothesis that continued opioid use was associated not only with the amount of pain experienced but also with other factors, such as patient age, smoking, and levels of depression.

To identify potential risk factors for continued opioid use in patients with sacroiliac joint (SIJ) pain, authors conducted a secondary analysis of data from an ongoing international randomized controlled trial comparing treatment outcomes after either CM or minimally invasive surgical management (MISM) in patients with LBP originating from the SIJ. Significant risk factors for continued opioid use were younger patient age and increases in LBP in the CM cohort and a lack of improvement in levels of depression in the MISM cohort. The results suggest that patients with LBP and continued opioid use should be evaluated not only for levels of pain but also for depression symptoms.

Abstract

Study Design: Secondary analysis of data from a randomized controlled trial. Objectives: To identify risk factors for continued opioid use after conservative management (CM) or minimally invasive surgical management (MISM) of low back pain (LBP) originating from the sacroiliac joint. Methods: Patients were randomized either to CM (n ¼ 49) or MISM (n ¼ 52). We documented opioid use, pain intensity (visual analogue scale [VAS]), Oswestry Disability Index (ODI), and the Zung depression score (Zung Self-Rating Depression Scale) at baseline and at months 3 and 6 after treatment initiation. Results: Compared with opioid nonusers, opioid users at baseline had higher mean levels of disability (ODI 61.5, standard deviation [SD] 13.3 vs ODI 51.5, SD 12.8; P < .01) and higher depression scores (Zung 48.5, SD 8.5, vs Zung 42.2, SD 7.2; P < .01). At 6 months, opioid users had higher 6-month pain levels (VAS 60.4, SD 24.0, vs VAS 42.4, SD 28.2; P < .01), higher disability scores (ODI 50.5, SD 16.2, vs ODI 32.7, SD 19.3; P < .01) and higher depression scores (Zung 47.6, SD 8.0, vs Zung 38.8, SD 8.9; P < .01). Risk factors for continued opioid use at 6 months were patient age (odds ratio [OR] for age ¼ 0.91; P ¼ .02) and an increase in LBP (OR 1.08; P ¼ .02) in the CM group and a lack of improvement in depression scores (OR 1.12; P ¼ .03) in the MISM group. Conclusions: In our patient cohort, the risk of continued opioid use in the treatment of LBP increased not only with pain intensity but also with levels of depression during the course of treatment.

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Article details
Risk Factors for Continued Opioid Use in Conservative Versus Surgical Management of Low Back Pain Originating From the Sacroiliac Joint
Julius Dengler, MD1, Bengt Sturesson, MD2, Djaya Kools, MD3, Domenico Prestamburgo, MD4, Daniel Cher, MD5, Eddie van Eeckhoven6, Emanuel Erk1, Alessandro Gasbarrini, MD7, Robert Pflugmacher, MD8, Peter Vajkoczy, MD1
2018, Vol. 8(5)
DOI: 10.1177/2192568217733707
Global Spine Journal

 

 

     
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