Effects of long-term opioid use for back pain

An August 2022 study (1) wanted to assess what happens to people on long-term opioid therapy for back-specific disability and health-related quality of life in patients with chronic low back pain. In this study there were 96 long-term opioid users and 204 long-term opioid nonusers.

In surveying the people of this study, the researchers found:

  • Long-term opioid use (more than 12 months) was a predictor of worse back-specific disability, physical function, fatigue, participation in social role, and pain interference outcomes.
  • Intermediate-term opioid use was a predictor of worse back-specific disability, physical function, fatigue, and sleep disturbance outcomes.
  • Short-term opioid use was a predictor of worse back-specific disability and physical function outcomes.

The researchers concluded: “The findings of this study are largely consistent with existing literature regarding the outcomes of long-term opioid therapy. Taken in conjunction with the well-established risks of opioid medications, these findings draw into question the utility of long-term opioid therapy for chronic low back pain.”

A November 2022 paper (2) 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.”

A May 2022 study (3) examined long-term spinal cord stimulation in patients with failed back surgery. At an average follow-up of 10.6 years, 78.5% of the patients were satisfied with the treatment outcome, with a significant pain reduction of an average three points on a Numeric Rating Scale (0-10) scale.

1 Schultz MJ, Licciardone JC. The effect of long-term opioid use on back-specific disability and health-related quality of life in patients with chronic low back pain. Journal of Osteopathic Medicine. 2022 Aug 11.
2 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.
3 Puylaert M, Nijs L, Buyse K, Vissers K, Vanelderen P, Nagels M, Daenekindt T, Weyns F, Mesotten D, Van Zundert J, Van Boxem K. Long-Term Outcome in Patients With Spinal Cord Stimulation for Failed Back Surgery Syndrome: A 20-Year Audit of a Single Center. Neuromodulation: Technology at the Neural Interface. 2022 May 14.

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