Opioid Use Persists In Many Patients After Common Spine Surgery
The prevalence of pain is far greater in the spine than anywhere else in the body. In fact, back pain ranks only behind skin disorders and osteoarthritis/joint disorders in top reasons to visit a doctor. Up to 80% of the general population will experience at least one episode of back pain in their lives, and about 65 million Americans report dealing with a back-related issue recently. So, if your back is bothering you right now, you’re far from alone.
Most cases of back pain will resolve on their own over time, and studies consistently show that patients with persistent or chronic back pain can improve from conservative interventions like physical therapy. But research has also shown that opioids represent one of the most prescribed treatments for back pain, either along with other conservative interventions or independently. The high risk for abuse and addiction with opioids is well documented by now, and these drugs also fail to truly resolve patients’ pain by only masking the sensation and tricking the brain that it has dissipated.
Surgical procedures like lumbar spinal fusion—which joins together two moveable bones in the lower back—is typically regarded as a last resort for chronic back pain, but rates of this surgery have been steadily increasing over the past few decades.
In addition, up to 70% of patients who decide to have surgery have already begun taking opioids by this point, with nearly 20% being dependent on opioids prior to their procedure. The use of opioids may affect outcomes, and most patients would prefer to not take opioids for an extended period after their procedure. But statistics show that continual use is somewhat common, both in patients taking opioids before surgery and in those who do not.
More than one in three patients are taking opioids six months after surgery
Therefore, a study was conducted to determine how many patients who undergo lumbar spinal fusion continue to take opioids in the long term. This type of study was called a systematic review, in which researchers performed a comprehensive search of four major medical databases to identify relevant studies that tracked the use of opioids in patients for at least six months after a lumbar spinal fusion procedure. A total of 329 studies were identified in the search that met all inclusion criteria. Of these, only 32 (9.7%) included data on the use of opioids, and only 21 (6.4% of all included studies) tracked the use of opioids for at least six months.
Analysis of this data revealed that the long-term use of opioids after surgery varied greatly from 6% to 86%. The average across all studies was 35%, with an average follow-up of 34 months. This suggests that more than one in three patients were taking opioids for at least six months after undergoing lumbar spinal fusion. The percentage of patients who were on opioids before the procedure also varied substantially, from 23% to 76%.
Based on these findings, it appears that many patients who have spine surgery continue to rely on opioids for pain relief for six months or more after their procedure. This contradicts with most patients’ expectations, as it is a common conception that surgery will automatically alleviate pain and eliminate the need for continual pain medication.
This information is particularly valuable for patients with chronic low back pain who are weighing the pros and cons of surgery.
While surgeries like lumbar spinal fusion may be appropriate and beneficial for certain patients, this study shows that it may not always lead to the outcomes that most patients expect, and it could maintain or create a reliance on opioids in the long term. For these reasons, we believe physical therapy is a much safer and more effective option for most cases of low back pain, since it can often produce long-term relief without the need for opioids.
Experiencing Lower Back Pain? Give Physical Therapy a Try
If you’re dealing with low back pain, we invite you to contact Bacci & Glinn Physical Therapy at 559-733-2478 (Visalia) or 559-582-1027 (Hanford) to learn more or to schedule an appointment today.
