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Medical College of Wisconsin study backs concern over opioid use
By John Fauber of the Journal Sentinel
New Orleans One year after undergoing spine surgery to relieve pain, about a third of patients still were using narcotic painkillers, according to a study that raises new concerns about the long-term use of the drugs.
The study by researchers at the Medical College of Wisconsin looked at 172 patients who underwent elective cervical spine surgery.
Despite a large percentage of the patients saying they were satisfied with the surgery, 51% of those who were using opioids before the surgery still were using the drugs one year later. Among those who were not using the drugs before surgery, 18% were found to be using them a year after their surgery.
Overall, 55 patients, or 32%, were using the drugs a year later.
The finding suggests that patients may become dependent on the drugs and have a difficult time getting off them, said Richard Deyo, a professor of family medicine at Oregon Health and Science University who has done research on back pain and opioid use.
"The worrisome thing is patients often are getting opioids because it is the easiest thing," said Deyo, who was not involved in the study.
Deyo said the study is in line with other research showing a high level of opioid use continued as far as two years after patients underwent lumbar spine surgery.
Opioid use increased dramatically during the 2000s as the drugs were prescribed more for chronic, non-cancer pain, though rigorous studies have not shown they are safe and effective when used that way.
Along with the increased use have been escalating numbers of overdose deaths and addiction.
Journal Sentinel/MedPage Today investigative reports have shown that the increased prescribing was linked to a push to liberalize use of the drugs by nonprofit medical societies that received millions of dollars in funding from opioid companies.
The new study, which was paid for by the Robert Wood Johnson Foundation, was presented Wednesday at the North American Spine Society annual meeting in New Orleans.
Marjorie Wang, the study's lead author, said she was surprised at the finding given that more than 70% of the patients reported being satisfied with the results of their surgery.
"There was sort of a disconnect there," said Wang, an associate professor of neurosurgery at the Medical College of Wisconsin who practices at Froedtert Hospital, where the surgeries took place. "I would have expected opioid use to go down."
Because opioid use was much higher at one year among those who already were taking the drug before their surgery, it suggests that starting someone on the drugs can lead to a chronic problem, she said.
Wang said it is not known who was prescribing the drugs a year later.
It could have been the surgeons, but it also could have been pain specialists or family practice doctors, she said.
http://m.jsonline.com/more/news/wat...rn-over-opioid-use-b99116917z1-227125121.html
Most of the surgeries involved spinal fusions that occurred between 2008 and 2011. The average age of the patients was 51.
The study shows that doctors need to do more to determine who should be getting opioids and who should not, said Heidi Prather, a professor of physical medicine and rehabilitation at Washington University in St. Louis.
"You have to look at it holistically," said Prather, who was not involved in the study.
She said sometimes patients demand opioids, but that doesn't mean they should always get them.
She said more needs to be done to find out if nonnarcotic alternatives should be used. Those include anti-seizure drugs, anti-depressants, anti-inflammatory drugs, exercise and cognitive behavioral therapy.
By John Fauber of the Journal Sentinel
New Orleans One year after undergoing spine surgery to relieve pain, about a third of patients still were using narcotic painkillers, according to a study that raises new concerns about the long-term use of the drugs.
The study by researchers at the Medical College of Wisconsin looked at 172 patients who underwent elective cervical spine surgery.
Despite a large percentage of the patients saying they were satisfied with the surgery, 51% of those who were using opioids before the surgery still were using the drugs one year later. Among those who were not using the drugs before surgery, 18% were found to be using them a year after their surgery.
Overall, 55 patients, or 32%, were using the drugs a year later.
The finding suggests that patients may become dependent on the drugs and have a difficult time getting off them, said Richard Deyo, a professor of family medicine at Oregon Health and Science University who has done research on back pain and opioid use.
"The worrisome thing is patients often are getting opioids because it is the easiest thing," said Deyo, who was not involved in the study.
Deyo said the study is in line with other research showing a high level of opioid use continued as far as two years after patients underwent lumbar spine surgery.
Opioid use increased dramatically during the 2000s as the drugs were prescribed more for chronic, non-cancer pain, though rigorous studies have not shown they are safe and effective when used that way.
Along with the increased use have been escalating numbers of overdose deaths and addiction.
Journal Sentinel/MedPage Today investigative reports have shown that the increased prescribing was linked to a push to liberalize use of the drugs by nonprofit medical societies that received millions of dollars in funding from opioid companies.
The new study, which was paid for by the Robert Wood Johnson Foundation, was presented Wednesday at the North American Spine Society annual meeting in New Orleans.
Marjorie Wang, the study's lead author, said she was surprised at the finding given that more than 70% of the patients reported being satisfied with the results of their surgery.
"There was sort of a disconnect there," said Wang, an associate professor of neurosurgery at the Medical College of Wisconsin who practices at Froedtert Hospital, where the surgeries took place. "I would have expected opioid use to go down."
Because opioid use was much higher at one year among those who already were taking the drug before their surgery, it suggests that starting someone on the drugs can lead to a chronic problem, she said.
Wang said it is not known who was prescribing the drugs a year later.
It could have been the surgeons, but it also could have been pain specialists or family practice doctors, she said.
http://m.jsonline.com/more/news/wat...rn-over-opioid-use-b99116917z1-227125121.html
Most of the surgeries involved spinal fusions that occurred between 2008 and 2011. The average age of the patients was 51.
The study shows that doctors need to do more to determine who should be getting opioids and who should not, said Heidi Prather, a professor of physical medicine and rehabilitation at Washington University in St. Louis.
"You have to look at it holistically," said Prather, who was not involved in the study.
She said sometimes patients demand opioids, but that doesn't mean they should always get them.
She said more needs to be done to find out if nonnarcotic alternatives should be used. Those include anti-seizure drugs, anti-depressants, anti-inflammatory drugs, exercise and cognitive behavioral therapy.
