Cutting Opioids Before Spine Surgery Improves Outcomes

Category: Spine Surgery | Author: Stefano Sinicropi | Date: May 22, 2017

Opioids Before Spine Surgery

A recent study presented at the American Association of Neurological Surgeons 2017 Annual Meeting suggests that reducing or eliminating opioid use prior to lumbar fusion surgery can lead to improved surgical outcomes.

The findings are interesting because a large number of patients with spine pain are prescribed some type of opioid medication to help manage pain and discomfort. With the new findings suggesting that these pills can inhibit surgical success, we may see a shift away from opioids, especially if surgery is on the table.

“The results suggest the use of opioid medication is a potentially modifiable factor that could be controlled to maximize clinical outcomes,” said study first author Alan T. Villavicencio.

Spine Surgery and Pain Pills

For their study, researchers analyzed surgical results from 93 patients who received either a one- or two-level lumbar fusion operation. The patients had an average age of 59 years old, and 60 of 93 patients had preoperatively used prescribed opioids. Here are some of the takeaways from the findings:

  • Individuals in the opioid group had higher preoperative disability ratings and lower mental health ratings than those in the non-opioid group.
  • Both groups had the same amount of back and leg pain in a preoperative summary assessment.
  • Patients were tracked for 12 months after surgery. At the end of 12 months, patients in the preoperative opioid group had significantly higher low back pain and disability, as well as lower health-related and mental health-related scores than the non-opioid group.

“In general, we found that the patients all got better whether they used opioids or not, but there was a statistically significant difference in the amount of improvement based on whether they used opioids preoperatively or not,” said Dr. Villavicencio. “This is the first study that has demonstrated this association in a homogeneous population of patients, which should be studied further to confirm these conditions.”

Proper Screenings

According to researchers, doctors and spine surgeons should conduct psychological and opioid screenings during the patient evaluation process. If surgery is a potential option, opioids should be avoided if possible, or at a minimum, doctors should work to help wean their patients off opioids prior to surgery. And aside from poorer surgical outcomes, there’s always the risk of opioid dependency after an operation.

“It’s clear that it’s better to try to get patients off of pain narcotics before surgery,” concluded Villavicencio. “When patients come in and they’re on a high dose of OxyContin, for instance, you know it’s probably going to be a bad outcome, so I always try to wean off or at least get them on much lower doses of narcotics.

The study is interesting, but it’s also worth noting that the researchers reported that individuals using opioids prior to surgery had higher disability scores, which certainly could impact post-op pain scores and total functional improvement. It’s not like all patients were exactly the same in all ways save for opioid intake, so it’s clear that opioids still hold value in terms of pain care. However, it certainly seems beneficial to try to wean patients off the medications as surgery approaches.

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