Painkiller Use Likely to Continue after Spine Surgery

Painkiller Use Likely to Continue after Spine Surgery

Over half of the patients who used opioid painkillers to relieve back pain were still using them a year after surgery to repair their spines, according to a new study that raised concerns about the long-term use of opioids.

bigstock-Pill-Bottle-2953772-300x199The small study, one of the first to study postoperative opioid use after spine surgery, followed 172 patients for 12 months after elective cervical spine surgery. Patients were asked about their opioid use both before and after the surgeries.

Researchers found that 51 percent of the patients who were using opioids before the surgery still were using the drugs a year later. And among those who were not using opioids before surgery, nearly 18% were using them one year later. Overall, 55 patients or 32% were using opioids a year after their surgeries.

But regardless of whether they used opioids or not, patients reported high levels of satisfaction with their surgeries. Over 70% of opioid and non-opioid users said they were extremely or somewhat satisfied with pain relief after surgery.

“Patients with and without 12-month opioid use reported similar functional outcome, bodily pain scores, and satisfaction with pain relief,” wrote lead author Marjorie Wang, MD, of the Medical College of Wisconsin.

Wang found the results surprising.

“There was sort of a disconnect there,” she told Medpage Today. “I would have expected opioid use to go down.”

Because opioid use continued for most patients after their surgeries – and because many were satisfied with the outcome of their surgeries — it suggests that taking the drugs can lead to long-term use.

“Interventions targeted at decreasing opioid use may need to focus on patient factors such as preoperative opioid use or duration of symptoms before surgery,” she said.

Wang believes more research is needed to see if non-narcotic alternatives can be used to treat back pain. That includes anti-seizure drugs, anti-depressants, anti-inflammatory drugs, exercise and cognitive behavioral therapy.

The findings were presented at the annual meeting of the North American Spine Society and published in The Spine Journal.

Authored by: Pat Anson, Editor

There are 5 comments for this article
  1. Trudy McGee at 9:01 pm

    I would like to see the authors of this study find out WHY people still were on opioids after surgery, instead of assume that people with back pain are merely drug seeking. Perhaps because the surgery didn’t work?? I had “curative” back pain surgery, and not only did it not help, it made everything WORSE! It is a simple syndrome, which nobody bothers to mention in this study, called FBSS. Google it authors! For the rest of the people who don’t know the name of their problem, it is caused failed back surgery syndrome.

  2. Stephen S. Rodrigues, MD at 11:11 am

    The Wrong Pain Paradigms
    That is because Surgery does not work in these cases … PERIOD! The paradigms are all wrong but are so embedded in modern medicine that these wrong paradigms are costing and wasting billions of dollars and contributing to mass misery.

    >You can’t fix pain with human hands. You can ignited natural healing with Therapy which is curative.
    >You can’t see pain with high technology. Whatever the scans show is not what causing the pain … until proven by failed therapy. Therapy, all aspects, rarely fails.
    >You can’t easily find pain just by the history and physical exam in the office. You can find pain with the use of Therapy.
    >You can’t use pills to medicate pain away. You can use Therapy to “heal” the pain away.
    >Opiates will cause dependency, tolerance and possibly addiction which will add a complex new problem layer … sometimes worse, more difficult and complex than the pain problem itself. Opiate withdrawal is an evil event to endure with sweats, diarrhea, gut cramps, mood upheaval and MORE pain!
    >Pain responds very very well to Therapy and should be the treatment of choice in the beginning, in the middle and forever.
    >Despite what folks will say … a massage, Chiropractic adjustment or manipulation can not truly do harm and is a valuable part of therapy.

    Myofascial Tissue Release Therapy is on a spectrum from simple stretching, yoga, massage, Chiro adjustments, John F. Barnes unwinding, hands-on manipulations, acupuncture, Gunn-IMS, dry needling to finally Travell trigger point injections.

  3. Janice Reynolds at 7:51 am

    They are addressing the wrong issue here. Persistent pain develops for various reasons but it is no longer pain which serves a purpose and the pain pathways are altered many times so surgery is not going to stop or change persistent pain-the damage is already done. The opioids are not the problem. There is an implication here that the patients like the opioids too much to give them up even though the “pain should be gone.” If opioids were effective for the persistent pain prior to the surgery there is no reason to believe they wouldn’t continue to be effective, perhaps being able to decrease them some now that the acute pain is no longer present. It is already known that opioids are not always effective for back pain (depends on what the cause is and the person and it is known adjuvant medication and non-pharmacological can decrease the need for opioids and in some cases work better. These include not only “anti-seizure drugs, anti-depressants, anti-inflammatory drugs, exercise and cognitive behavioral therapy” they mentioned but also Lidoderm patches, massage therapy, chiropractic therapy, osteopathic manipulation, etc. (although I can see why spinal surgeons may be leery of the later two).

  4. Julie Anna Bloodworth at 1:27 pm

    The reason the most post-op back surgery patients still take opioids after “successful” surgery is because they STILL HURT! I feel that this article is very one-sided and doesn’t look at all of the factors. My Neurosurgeon told me BEFORE my surgery that I would probably be on pain medications for the rest of my life. My Spinal Fusion with Instrumentation was a “successful” surgery and I was able to half my opioid use, however, I still have to have pain meds to make my life bearable. The surgery took my pain level from a daily 8-10 down to 4-6 but I still have spikes into level 9. I thinks people have become too fixated on people that medically REQUIRE opioids to have a somewhat normal life. To me, opioids or no different than the High Blood Pressure pills or Insulin. If it is medically necessary, it shouldn’t matter what the name is – it is medically necessary. Instead of focusing on Pain Patients, focus on the people that are breaking the law.

  5. Nancy at 10:42 am

    Well that is because the surgery does not work. I had lumbar surgery and when I was done my back hurt more than it did prior to the surgery. The surgeon said well I said it will only help your leg pain. Well I did not have leg pain so I guess he was not listening to me. I worked at a hospital in a job that required long hours sitting at a computer without breaks so then I had a cervical fusion, which not only didn’t work it caused my T-1 and T-2 to rupture, I could not move my arms and it felt like an elephant was sitting on my chest. Of course they wanted to do surgery again and I said NO, so I went to physical therapy. But the pain never went away and I received a promotion and my hours increased even more. Well then I had a small Morton’s Neuroma removed from my foot because I could not wear shoes. Well that did it, after that surgery I had severe nerve damage. I was diagnoised with peripheral neuropthy and small fiber neuropathy, spondylosis, DJDD, dystonia, I ended up in a wheel chair and in my early 50’s after I worked so hard to work my way up in my company, I ended up disabled and unable to work at all. So please unless it is life or death don’t rush to get any surgery on your back. I wanted a quick fix. I worked too many hours and I paid a huge price for it. So I am on more pain medications than I ever was on prior to these surgeries and I suffer with horrific pain and my life is a life of pain and misery.