Taper Opioids Before SCS Trial?

[drusso]

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Opioids, Benzos Affect Spinal Cord Stimulation Test

"Our research findings underscore a potential negative impact of opioids plus sedative medications on SCS outcomes," Odonkor said. "It may be prudent for clinicians to have a conversation with their patients about why it may be important to wean them off sedative medications and opioids prior to attempting neuromodulation therapies."

 

[callmeanesthesia]

Opioids, Benzos Affect Spinal Cord Stimulation Test

"Our research findings underscore a potential negative impact of opioids plus sedative medications on SCS outcomes," Odonkor said. "It may be prudent for clinicians to have a conversation with their patients about why it may be important to wean them off sedative medications and opioids prior to attempting neuromodulation therapies."

It’s hard to shove the leads high enough to treat the pain source for patients on high dose opioids and benzos...😵

If you look at the patient characteristics for the Senza trial, the average patient was on about 100MME per day. I’m surprised they got the outcomes they did.

Personally I think it’s a great way to weed out poor SCS candidates to ask them to quit smoking and wean down on opioids. Only the ones with some self-efficacy are going to cross that bar, and your outcomes will thank you for it.

 

[kstarm]

Despite the numerous, numerous articles that show worse outcomes across the board for surgeries if people are on chronic opioids pre-operatively, there is almost no data on the effects of tapering pre-op-because no one wants to do the heavy lifting of opioid tapers. Just because you get someone's MED to zero before surgery doesn't mean their nervous system magically rewires itself and they are suddenly the equivalent of opioid-naive. If anything they may be having low-grade withdrawal, and a lot more psychological distress as the opioids are no longer blunting their affect, and allowing them to disconnect from the painful feelings and emotions within their bodies. It is one of the things that drives me crazy about all these studies that show opioids pre-op equals worse outcomes. They all recommend opioid tapering because of this, yet there is essentially no data to support it, and I am curious how many surgeons/interventionalist who write these studies and recommend tapering actually do it. If they did they would see how difficult it can be, and how long it can take for chronic pain/chronic opioid users to get to a better place for pre-op readiness.

 

[soccrwz]

I believe senza showed a decrease of only 10 MME with therapy from like 110 to 100 or something similar

 

[painfree23]

Despite the numerous, numerous articles that show worse outcomes across the board for surgeries if people are on chronic opioids pre-operatively, there is almost no data on the effects of tapering pre-op-because no one wants to do the heavy lifting of opioid tapers. Just because you get someone's MED to zero before surgery doesn't mean their nervous system magically rewires itself and they are suddenly the equivalent of opioid-naive. If anything they may be having low-grade withdrawal, and a lot more psychological distress as the opioids are no longer blunting their affect, and allowing them to disconnect from the painful feelings and emotions within their bodies. It is one of the things that drives me crazy about all these studies that show opioids pre-op equals worse outcomes. They all recommend opioid tapering because of this, yet there is essentially no data to support it, and I am curious how many surgeons/interventionalist who write these studies and recommend tapering actually do it. If they did they would see how difficult it can be, and how long it can take for chronic pain/chronic opioid users to get to a better place for pre-op readiness.

Do you have a link to articles that show pre op opiates leads to bad outcomes for surgery

 

[kstarm]

Do you have a link to articles that show pre op opiates leads to bad outcomes for surgery

• 
  Impact of Preoperative Opioid Use on Total Knee Arthroplasty Outcomes-J Bone Joint Surg Am. 2017 May 17;99
  
  
• Opioid use prior to total hip arthroplasty leads to worse clinical outcomes- International Orthopaedics (SICOT) (2014) 38:1159–1165
  
  
• Narcotic Use and Total Knee Arthroplasty- J Arthroplasty. 2017 Aug 17
  
  
• Long-Acting Opioid Use Independently Predicts Perioperative Complication in Total Joint Arthroplasty. -J Arthroplasty. 2016 Sep;31(9 Suppl):170-174
  
  
• Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery.-Clin Orthop Relat Res. 2015 Jul;473(7):2402-12
  
  
• Preoperative narcotic use as a predictor of clinical outcome: results following anterior cervical arthrodesis.-Spine (Phila Pa 1976). 2008 Sep 1;33(19):2074-8
  
  
• Prediction based on preoperative opioid use of clinical outcomes after transforaminal lumbar interbody fusions.-J Neurosurg Spine. 2017 Feb;26(2):144-149
  
  
• Prolonged preoperative opioid therapy associated with poor return to work rates after single level cervical fusion for radiculopathy for patients receiving Workers’ Compensation benefits. Spine (Phila Pa 1976). 2016 Jul 08;(Jul):8. Epub 2016 Jul 8.
  
  
• Preoperative opioid use as a predictor of adverse postoperative self reported outcomes in patients undergoing spine surgery. J Bone Joint Surg Am. 2014 Jun 04;96(11):e89. Epub 2014 Jun 4
  
  
• Effect of Preoperative Opioid Exposure on Healthcare Utilization and Expenditures Following Elective Abdominal Surgery.-Ann Surg. 2017 Apr;265(4):715-721
  
  
• Preoperative Opioid Use is Independently Associated With Increased Costs and Worse Outcomes After Major Abdominal Surgery.-Ann Surg. 2017 Apr;265(4):695-701