Patients taking opioids for lumbar pain have differing surgical expectations

CHICAGO — Patients who have a higher use of opioid medications have lower surgical expectations and are less likely to expect to be free of analgesics after surgery compared with patients who have low-dose opioid use, according to a study presented at the North American Spine Society Annual Meeting.

“Not all opioid patients are equal in terms of expectations from surgery. I think it is important as we look at these groups going forward that we are comprehensive in how we take their histories. This is not only in their exact dosing regimens that they have been on — not just their current type of dosing regimen — but also comprehensively, and their history and behavior with those medications and, of course, the timeline of them,” Alexander P. Hughes, MD, said during his presentation.

Hughes and colleagues studied 77 patients who were scheduled for lumbar surgery and had chronic opioid use for a prospective, cross-sectional study which was conducted at a tertiary spine center. The investigators compared the amount of opioid use vs. clinical and psychological characteristics, including patients’ surgical expectations. Outcome measures included Hospital for Special Surgery Lumbar Spine Surgery Expectations Survey and the Oswestry Disability Index (ODI).

Researchers identified patients who took chronic opioids for a mean of 10 days preoperatively. Opioid use was grouped by dose. Overall, 44 patients met the criteria for high-dose opioid use, meaning patients took a morphine equivalent dose of greater than or equal to 120 mg/day and/or had taken opioids for 6 months or more. Thirty-three patients met the criteria for low-dose opioid use, which was defined as patients who took a morphine equivalent dose of less than 120 mg/day and took opioids for less than 6 months. Mean patient age was 58 years with 57% of enrolled patients being male and 82% having chronic lumbar diagnoses. Patients initially completed a valid 20-item survey to measure physical and psychological expectations of surgery and noted their anticipated improvement after surgery.

Hughes said the mean expectations survey score was 73±6, the mean ODI score was 49±14 and the mean overall back pain was 7±22. Researchers found 44% of patients positively screened for depression and 68% of patients had anxiety scores greater than those found in the general population.

Hughes said more patients in the high-dose opioid group had chronic lumbar conditions, previous surgeries and full-time employment compared with patients in the low-dose opioid group. High-dose opioid patients also had lower expectation survey scores. Fewer patients in the high-dose opioid group had the expectation that surgery would completely improve pain, improve pain that interfered with sleep and would allow them to be free of long-term analgesics. – by Kristine Houck, MA, ELS

Reference: Sax O, et al. Paper #72. Presented at: North American Spine Society Annual Meeting; Oct. 14-17, 2015; Chicago.

Disclosure: Hughes reports no relevant financial disclosures.