People with back pain, may, in many instances, suffer from terrible pain. It is typically in these patients where opioids are prescribed as a means to manage pain until surgery can be performed. As we will see in the research below, there are many setbacks to pre-surgical opioid usage. Latter in this article we will address alternatives, not only to opioid use but alternatives to the surgery you are being pain managed for.
Nearly 20-29% of patients prescribed opioid pain medications misuse them and roughly 12% go on to develop an opioid addiction.
An April 2023 study (1) brought light on problems facing the back surgeon treating pain after spinal surgery, especially in patients who utilized opioids from 1-3 months prior to surgery. “Spine surgeons are placed in a challenging situation when trying to treat post-operative pain. They are the third highest prescribers of opioids among physicians in the United States. This is concerning given that nearly 20-29% of patients prescribed opioid pain medications misuse them and roughly 12% go on to develop an opioid addiction.”
Higher odds of hardware failure
A large scale January 2024 paper (2) investigated the long-term preoperative use of NSAID and opioids in patients with low back pain and the resultant postoperative complications following lumbar fusion. Long-term opioid users had significantly higher readmission rates (and complication) compared to long-term NSAID users. In addition, they found that long-term NSAID users had significantly higher odds of hardware failure at long-term follow-up in patients receiving lumbar fusion surgery.
Poorer outcomes following spinal surgery
An August 2023 study (3) wrote that the current medical research “has general consensus that preoperative opioid use leads to poorer outcomes following spinal surgery. (This study) highlights some common themes identified in this patient population. Namely, preoperative opioid exposure in patients undergoing spinal surgery is associated with increased risk of postoperative chronic opioid therapy, decreased return to work rates, increased length of hospitalization, and increased healthcare costs.”
A November 2022 paper (4) examined opioid use for chronic pain prior to spinal surgery and the increased rate of post-operative adverse events in these patients. A subgroup of 2,112 patients using opioids preoperatively were followed. The researchers found “significantly higher incidence of infection compared to non-opioid users.” The researchers concluded: “Consistent with prior publications, opioid use was significantly associated with a higher incidence of two-year post-operative infection compared to non-use. Low-dose opioid users had higher post-operative infection rates than non-users.”
An April 2020 study (5) also identified prior opioid use before spinal surgery. The authors write: “Patients on chronic opioids prior to spine surgery are more likely to have a longer hospital stay and continue on opioids for a longer time after surgery, compared with patients not on chronic opioid therapy.”
Alternatives to opioids for back pain
Many people are prescribed opioids because they have already failed at pain management with NSAIDs, acetaminophen, corticosteroids, antidepressants, and anticonvulsants et al. yet these medication are listed as alternatives. The idea of surgical intervention is to get a patient out of pain and as an added benefit, off of the need for opioids or other pain management regiments.
At our practice we utilize Platelet-Rich Plasma as one of our care programs for the patient with chronic low back pain. We may also utilize bone marrow derived stem cell therapy. The decision as to which one of these methods to use is based on an examination in the office and an assessment of the person’s pain and functional difficulties along with the patient’s goal of recovery. Someone who needs to return to work as a landscaper will have a different recovery priority than a retired individual with lesser physical demands on his/her back.
Stem cell injections
- Bone marrow stem cell injections help restore ligaments strength by causing the regeneration of ligament, tendon, cartilage and bone regeneration. Bone Marrow Concentrate is an injection therapy that has the potential to improve lower back patients’ quality of life.
Bone Marrow Concentrate is a solution that contains many cytokines and growth factors but most notably contains platelets and mesenchymal stem cells (MSCs). MSCs are adult multipotent stem cells that have the ability to differentiate into different cell types such, cartilage, bone, and muscle to help repair and stabilize the spine. This can be a promising solution for many patients.
Call for a free phone consultation with our staff 800-300-9300
Related articles
Effects of long-term opioid and painkiller use for back pain
Are spinal surgeries as successful as we think? Failed back surgery syndrome.
References
1 Kowalski C, Ridenour R, McNutt S, Ba D, Liu G, Bible J, Aynardi M, Garner M, Leslie D, Dhawan A. Risk factors for prolonged opioid use after spine surgery. Global Spine Journal. 2023 Apr;13(3):683-8.
2 Ballatori AM, Shahrestani S, Ton A, Chen X, Gettleman BS, Buser Z, Wang JC. Post-Operative Complications Associated with Long-Term NSAID or Long-Term Opioid Use Prior to Lumbar Spinal Fusion Surgery. Clinical Neurology and Neurosurgery. 2024 Jan 1;236:108093.
3 Fortier L, Sinkler MA, De Witt AJ, Wenger DM, Imani F, Morsali SF, Urits I, Viswanath O, Kaye AD. The Effects of Opioid Dependency Use on Postoperative Spinal Surgery Outcomes: A Review of the Available Literature. Anesthesiology and Pain Medicine. 2023 Aug;13(4).
4 Gonzalez GA, Corso K, Miao J, Rajappan SK, Porto G, Anandan M, O’Leary M, Wainwright J, Smit R, Hines K, Franco D. Does pre-operative opiate choice increase risk of post-operative infection and subsequent surgery?. World Neurosurgery. 2022 Nov 14.
5 Stephanie TK, Scheman J, Davin S, Benzel EC. The impact of preoperative chronic opioid therapy in patients undergoing decompression laminectomy of the lumbar spine. Spine. 2020 Apr 1;45(7):438-43.