Opioid use has no effect on spine rehab outcomes

Investigation comparing patients taking opioids and those not taking them found no significant differences.

A study comparing patients in rehabilitation for chronic disabling spinal disorders found no significant differences in terms of outcomes or attrition between those taking opioids and those who did not.

Rowland G. Hazard, MD, professor of orthopedics and rehabilitation at the University of Vermont, and colleagues studied 115 consecutive chronic spine pain patients who completed a two-week rehabilitation program and were followed for six weeks. Half of the patients used opioids to help control pain.

Hazard presented the results at the International Society for the Study of the Lumbar Spine 32nd Annual Meeting.

Surprising findings

“Comparing opioid and non-opioid patients ... the opioid patients had worse somatization scores; however, when looking at all the other variables, there were no significant differences between these two groups,” Hazard said.

He acknowledged that his study had some flaws, including the length of follow-up, tracking opioid use and quantifying the intensity of treatments. “The best study would be a double-blind ... controlled trial involving patients taking opioids, and randomize them [regarding] whether continue or not,” he said.

Nevertheless, his results surprised many in attendance. The study involved patients with an average age of 39 years and included a similar number of men and women. Groups had no significant differences in terms of age, work status or the percentage of patients receiving worker’s compensation benefits. Overall, 71% received worker’s compensation and 75% did not work at the time of the study.

Patients in the opioid group tested lower in range of motion and had worse SF-36 scores for pain and for Oswestry Disability Index (ODI) scores, he said.

No significant difference

In the study, the researchers recorded opioid use, but doses were not controlled. Opioid use also was not considered in prescribing or guiding rehabilitation.

The rehabilitation program included physical training and cognitive behavioral therapy and education. Patients participated in the program eight hours per day, five days per week for two weeks.

The researchers did identify a trend towards higher drop out rates in the opioid-treated group, though it was not statistically related completion of the rehabilitation program or to completion of follow-up at six weeks, Hazard said.

Overall, both groups had improvements in SF-36 physical scores, ODI, physical demand level and bodily pain scores. The opioid group had lower scores in somatization testing, however.

“In tertiary care centers like we have, the vast majority of patients who are being referred for rehabilitation are on high doses of opioids,” he said.

“When you are in the room with a patient and you are trying to decide whether intensive rehabilitation is a good idea, you have to make a decision whether to tell the patient to stop taking the opioid or keep going. That is where a double-blind, randomized, controlled study would be helpful,” he added.

For more information:
Hazard R. Walsh T. Spratt K. et al. The effect of opioids on rehabilitation outcome for people with chronic disabling spinal disorders. #54. Presented at the International Society for the Study of the Lumbar Spine 32nd Annual Meeting May 10-14, 2005. New York.