Spine Treatment Appraisal Report (STAR): Patient-Reported Reasons for Persistent Opioid Use Following Elective Spine Surgery

Uhrbrand P, Helmig P, Haroutounian S, Vistisen ST, Nikolajsen L. Persistent Opioid Use After Spine Surgery: A Prospective Cohort Study. Spine (Phila Pa 1976). 2021 Oct 15;46(20):1428-1435.

Visual Abstract

Why Is This Study an Important Topic?

A large number of patients prescribed opioids fail to discontinue opioid treatment months to years after surgery. There is limited evidence on why patients continue to take opioids following spine surgery, a high-risk procedure concerning persistent opioid use.

What Are the Primary Clinical Questions?

What are the reasons for persistent opioid use following elective spine surgery, what is the frequency of withdrawal symptoms during opioid tapering, and what pain-related care is sought a

Table 1.

Study Characteristics

Population	Male (37%) and female (63%) adults, mean age 65 years following planned spine surgery for back pain caused by a herniated intervertebral disc, scoliosis, spondylosis, spondylolisthesis, or spinal stenosis. Excluded: Severe physical comorbidity or inability to participate
Intervention	Spinal fusion only, decompression only, or spinal decompression plus fusion
Prognostic factor	Preop opioid use vs preop opioid nonuse
Outcomes	Frequency of postop daily opioid use, reasons for continued opioid use, frequency of withdrawal symptoms, and characterization of pain-related contacts to health care after discharge
Time	3 and 6 months

fter discharge?

Results

Result 1. Postop Daily Opioid Use Comparing Patients With Preop Opioid Use vs Patients With No Preop Opioid Use.

Result 2. Reason for Continued Opioid Use 3 Months Postop (N = 105). Patients Were Allowed to Provide More Than One Answer.

Result 3. Frequency of One or More Withdrawal Symptoms During Opioid Tapering the First 3 Months Postop.

Result 4. Pain-Related Contacts to Health Care After Discharge 3 Months Postop (52%). Patients Were Allowed to Provide More Than One Answer.

How Will This Affect the Care of my Patients?

Persistent opioid use after spine surgery is often consumed due to reasons other than surgery-related pain. Studies are needed to identify high-risk patients and facilitate successful and safe opioid tapering in patients undergoing spine surgery.