Risk Factors For Prolonged Opioid Use After Spine Surgery

Study Design: Retrospective review. Objective: Our purpose was to evaluate factors associated with increased risk of prolonged post-operative opioid pain medication usage following spine surgery, as well as identify the risk of various post-operative complications that may be associated with pre-operative opioid usage. Methods: The MarketScan commercial claims and encounters database includes approximately 39 million patients per year. Patients undergoing cervical and lumbar spine surgery between the years 2005-2014 were identified using CPT codes. Pre-operative comorbidities including DSM-V mental health disorders, chronic pain, chronic regional pain syndrome (CRPS), obesity, tobacco use, medications, and diabetes were queried and documented. Patients who utilized opioids from 1-3 months prior to surgery were identified. This timeframe was chosen to exclude patients who had been prescribed pre- and post-operative narcotic medications up to 1 month prior to surgery. We utilized odds ratios (OR), 95% Confidence Intervals (CI), and regression analysis to determine factors that are associated with prolonged post-operative opioid use at 3 time intervals. Results: 553,509 patients who underwent spine surgery during the 10-year period were identified. 34.9% of patients utilized opioids 1-3 months pre-operatively. 25% patients were still utilizing opioids at 6 weeks, 17.3% at 3 months, 12.7% at 6 months, and 9.0% at 1 year after surgery. Pre-operative opioid exposure was associated with increased likelihood of post-operative use at 6-12 weeks (OR 5.45, 95% CI 5.37-5.53), 3-6 months (OR 6.48, 95% CI 6.37-6.59), 6-12 months (OR 6.97, 95% CI 6.84-7.11), and >12 months (OR 7.12, 95% CI 6.96-7.29). Mental health diagnosis, tobacco usage, diagnosis of chronic pain or CRPS, and non-narcotic neuromodulatory medications yielded increased likelihood of prolonged post-op opioid usage. Conclusions: Pre-operative narcotic use and several patient comorbidities diagnoses are associated with prolonged post-operative opioid usage following spine surgery. Chronic opioid use, diagnosis of chronic pain, or use of non-narcotic neuromodulatory medications have the highest risk of prolonged post-operative opioid consumption. Patients using opiates pre-operatively did have an increased 30 and 90-day readmission risk, in addition to a number of serious post-operative complications. This data provides spine surgeons a number of variables to consider when determining post-operative analgesia strategies, and provides health systems, providers, and payers with information on complications associated with pre-operative opioid utilization.

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Opioid Use, Perioperative Risks, and Associated Postoperative Complications in Foot and Ankle Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00063 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0006

Author(s):

Ryan M. Ridenour ◽

Christopher Kowalski ◽

Djibril Ba ◽

Guodong Liu ◽

Jesse Bible ◽

...

Keyword(s):

Chronic Pain ◽

Tobacco Use ◽

The United States ◽

Foot And Ankle ◽

Opioid Use ◽

Dsm V ◽

Increased Risk ◽

Ankle Surgery ◽

Operative Complications ◽

Post Operative Complications

Category: Ankle, Midfoot/Forefoot, Opioid Use Research Introduction/Purpose: Within the United States, opioid abuse has become a national crisis. Twenty-nine percent of patients prescribed opioids misuse them with nearly 12% developing addiction. One previous study has shown that patients undergoing foot/ankle surgery were left with extra narcotic pain medications following surgery, many of whom would have preferred to dispose of them. Our purpose was to evaluate factors in foot and ankle surgery that are associated with increased risk of prolonged post-operative opioid pain medication usage and identify the risk of various post-operative complications that may be associated with pre-operative opioid usage. We hypothesize that pre-operative opioid use will place patients at an increased risk of post-operative usage. Methods: The MarketScan commercial claims and encounters database, including approximately 39 million patients per year, was searched to identify patients who underwent foot/ankle surgery based on CPT code from 2005-2014. Preoperative comorbidities including DSM-V mental health disorders, chronic pain, chronic regional pain syndrome (CRPS), obesity, tobacco use, medications and diabetes were queried and documented. Patients who utilized opioids at least one month up to 3 months prior to surgery were identified. This timeframe was chosen to exclude patients who had been prescribed post-operative narcotic medications up to 1 months pre-operatively. We utilized odds ratios (OR), 95% Confidence Intervals (CI), and regression analysis to determine factors that are associated with prolonged post-operative opioid use at 3 time intervals. Results: 112,893 patients underwent foot/ankle surgery. 11,523 (10.2%) patients utilized opioids 1-3months pre-operatively. Of those, 5,732 (5.0%) utilized opioids post-operatively at 6 weeks, 4,364 (3.8%) at 3 months, 3,475 (3.08%) at 6 months and 2,579 (2.2%) at 1 year. Pre-operative opioid use was associated with increased post-operative use (6-12weeks: OR 7.24, 95% CI 6.92- 7.58; 3-6months: OR 11.03, 95% CI 10.45-11.63; 6-12months: OR 14.1, 95% CI 13.3-15.1; >12months: OR 14.74, 95% CI 13.68-15.88). Tobacco use, chronic pain, DSM-V diagnosis and non-opioid analgesia yielded increased risk of post-operative opioid usage. Diagnosis of CRPS, obesity or diabetes did not have an increased risk. Pre-operative opioid use was associated with an increased risk of readmission, DVT, pulmonary embolism, I&D of surgical site, myocardial infarction, UTI and post-operative bleeding (Table 1). Conclusion: Our study found a number of factors that are associated with prolonged post-operative opioid usage which included pre-operative opioid use 1-3months before surgery, tobacco use, chronic pain, DSM-V diagnoses and pre-operative use of certain non-opioid medications. We also found patients with pre-operative opioid exposure to be at an increased risk of a number of significant post-operative complications, including an increased risk of readmission at 30 and 90 days. This data provides orthopaedic surgeons a number of variables to consider when determining post-operative analgesia strategies, and provides health systems, providers and payers information on complications associated with pre-operative opioid utilization.

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Persistent Spinal Pain Syndrome: a proposal for Failed Back Surgery Syndrome and ICD-11

Pain Medicine ◽

10.1093/pm/pnab015 ◽

2021 ◽

Author(s):

Nick Christelis ◽

Brian Simpson ◽

Marc Russo ◽

Michael Stanton-Hicks ◽

Giancarlo Barolat ◽

...

Keyword(s):

Chronic Pain ◽

Spine Surgery ◽

Pain Syndrome ◽

Spinal Pain ◽

Failed Back Surgery Syndrome ◽

Medical Professionals ◽

Failed Back Surgery ◽

Back Surgery ◽

Spinal Pain Syndrome

Abstract Objective For many medical professionals dealing with patients with persistent pain following spine surgery, the term failed back surgery syndrome (FBSS) as a diagnostic label is inadequate, misleading and potentially troublesome. It misrepresents causation. Alternative terms have been suggested but none has replaced FBSS. The International Association for the Study of Pain (IASP) published a revised classification of chronic pain, as part of the new International Classification of Diseases (ICD-11), which has been accepted by the World Health Organization (WHO). This includes the term Chronic pain after spinal surgery (CPSS), which is suggested as a replacement for FBSS. Methods This article provides arguments and rationale for a replacement definition. In order to propose a broadly applicable yet more precise and clinically informative term, an international group of experts was established. Results 14 candidate replacement terms were considered and ranked. The application of agreed criteria reduced this to a shortlist of four. A preferred option – Persistent spinal pain syndrome – was selected by a structured workshop and Delphi process. We provide rationale for using Persistent spinal pain syndrome and a schema for its incorporation into ICD-11. We propose the adoption of this term would strengthen the new ICD-11 classification. Conclusions This project is important to those in the fields of pain management, spine surgery and neuromodulation, as well as patients labelled with FBSS. Through a shift in perspective it could facilitate the application of the new ICD-11 classification and allow clearer discussion amongst medical professionals, industry, funding organisations, academia, and the legal profession.

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PAIN SYNDROME AND PAIN MANAGEMENT AFTER LUMBAR SPINE SURGERY

Pain anesthesia and intensive care ◽

10.25284/2519-2078.3(88).2019.177391 ◽

2019 ◽

Vol 0 (3(88)) ◽

pp. 23-26

Author(s):

М. В. Лизогуб ◽

М. А. Георгіянц ◽

К. І. Лизогуб ◽

А. О. Хмизов

Keyword(s):

Lumbar Spine ◽

Pain Management ◽

Spine Surgery ◽

Pain Syndrome ◽

Lumbar Spine Surgery

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0259 Shiftworkers are at Increased Risk of Developing Chronic Pain and Opioid Use Disorders: A Study of 116,000 UK Biobank Participants Over a Decade

SLEEP ◽

10.1093/sleep/zsaa056.257 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A98-A99

Author(s):

L Gao ◽

P Li ◽

L Cui ◽

Y Luo ◽

C Vetter ◽

...

Keyword(s):

Chronic Pain ◽

Bone Fractures ◽

Inflammatory Diseases ◽

Opioid Use Disorder ◽

Uk Biobank ◽

Opioid Use ◽

Logistic Regression Models ◽

Diagnostic Coding ◽

Increased Risk ◽

Opioid Use Disorders

Abstract Introduction In the current epidemic of opioid-related deaths, and widespread use of opioids to treat chronic pain, there is a pressing need to understand the underlying risk factors that contribute to such devastating conditions. Shiftwork has been associated with adverse health outcomes. We tested whether shiftwork during middle age is linked to the development of chronic pain and opioid misuse. Methods We studied 116,474 participants in active employment between 2006–2010 (mean age 57±8; range 37–71) from the UK Biobank, who have been followed for up to 10 years until 2017. We included participants who were free from all forms of self-reported pain, and were not taking opioid medications at baseline. Chronic pain and opioid use disorder diagnoses were determined using hospitalization records and diagnostic coding from ICD-10. Multivariate logistic regression models were performed to examine the associations of shiftwork status (yes/no) and nightshift frequency (none/occasional/permanent) and with incident chronic pain and/or opioid use disorder during follow-up. Models were adjusted for demographics, education, Townsend deprivation index, major confounders (BMI, diabetes, bone fractures/injuries, operations, peripheral vascular disease, joint/inflammatory diseases, cancer, standing/manual labor at work) and covariates (smoking, alcohol, high cholesterol, depression/anxiety, and cardiovascular diseases). Results In total, 190 (1.6/1,000) developed chronic pain or opioid use disorders. Shiftworkers (n=17,673) saw a 1.5-fold increased risk (OR 1.56, 95% CI: 1.08–2.24, p=0.01) relative to day workers. Within shiftworkers, those who reported occasional nightshift work (n=3,966) were most vulnerable (OR 1.57, 95% CI: 1.06–2.34, p=0.02). Results remained similar after adjusting for baseline sleep duration, chronotype and insomnia. Conclusion Shiftwork, and in particular rotating nightshift work is associated with increased risk for developing chronic pain and opioid use disorders. Replication is required to confirm the findings and to examine underlying mechanisms. Support This work was supported by NIH grants T32GM007592, RF1AG064312, and RF1AG059867.

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A 57-year-old male with chronic pain syndrome, anxiety disorder, and hypertension is seeking mental health counseling

Case Studies in Pain Management ◽

10.1017/cbo9781107281950.053 ◽

2014 ◽

pp. 373-378

Author(s):

Natacha Telusca ◽

Kingsuk Ganguly

Keyword(s):

Mental Health ◽

Chronic Pain ◽

Anxiety Disorder ◽

Pain Syndrome ◽

Mental Health Counseling ◽

Chronic Pain Syndrome ◽

Health Counseling

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Peri-operative complications of lumbar spine surgery in patients over eighty five years of age: a retrospective cohort study

International Orthopaedics ◽

10.1007/s00264-018-3875-1 ◽

2018 ◽

Vol 42 (5) ◽

pp. 1083-1089 ◽

Cited By ~ 3

Author(s):

Shingo Onda ◽

Masahiro Kanayama ◽

Tomoyuki Hashimoto ◽

Fumihiro Oha ◽

Akira Iwata ◽

...

Keyword(s):

Cohort Study ◽

Lumbar Spine ◽

Spine Surgery ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Lumbar Spine Surgery ◽

Operative Complications

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Review of psychiatric comorbidities and their associations with opioid use in elective lumbar spine surgery

Medicine ◽

10.1097/md.0000000000023162 ◽

2020 ◽

Vol 99 (47) ◽

pp. e23162

Author(s):

Frank M. Mezzacappa ◽

Kyle P. Schmidt ◽

Steven O. Tenny ◽

Kaeli K. Samson ◽

Sandeep K. Agrawal ◽

...

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Lumbar Spine Surgery ◽

Opioid Use ◽

Psychiatric Comorbidities

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FACTORS OF INFLUENCE ON PAIN INTENSITY AND FUNCTIONAL ACTIVITY OF PATIENTS WITH BACK PAIN OF DIFFERENT LOCALIZATION

PRECARPATHIAN BULLETIN OF THE SHEVCHENKO SCIENTIFIC SOCIETY Pulse ◽

10.21802/10.21802/2304-7437-2019-5(57)-35-43 ◽

2019 ◽

pp. 35-43

Author(s):

I. G. Maslova ◽

N. O. Mykhailovska ◽

T. M. Slobodin

Keyword(s):

Mental Health ◽

Chronic Pain ◽

Back Pain ◽

Pain Syndrome ◽

Anxiety And Depression ◽

Vital Activity ◽

Lower Back ◽

Sf 36 ◽

Factors Of Influence ◽

High Level

In order to identify the probable factors of the effect on the intensity of the pain syndrome and the parameters of the functioning of patients with back pain, depending on the location of the pain syndrome and concomitant pathology, 139 patients with non-specific back pain who were in inpatient treatment in the medical and sanitary part of JSC "Motor -Sich "with the first detected acute pain syndrome and acute exacerbation of chronic. The results of the study revealed a decrease in the level of physical functioning, deterioration of vital activity and the state of general and mental health (on the scale of SF-36) in patients with exacerbation of chronic pain, the lowest indicators of vital activity, social functioning, mental health and a high level of anxiety and depression - in patients with cervical and cranial localization of pain syndrome, despite the fact that patients with localized pain in the lower back are markedly higher levels of pain not only for YES, but also zg BP bottom axis scale SF-36. Patients with a combination of arterial hypertension and diabetes have been shown to have chronic pain syndrome.

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