Painkiller overuse in pain management after neck and back surgery

In the more than 20 years of practice, we have seen our share of patients who come into our office with long-histories of spine and neck pain, surgical intervention and a long history of painkiller, opioid use. While many people have very successful spinal surgeries, some people do not. Following surgery their pain increased and now they are living on prescription painkillers. Some have found relief with spinal cord stimulators, other do not and now their seemingly only option is pain management.

Not all painkiller problems come with a failed surgery. Some people have very successful surgeries but were prescribed more medication than they probably should have had.

Clinicians often prescribe excessive number of discharge opioids

In an April 2020 study (1), a concern was raised. “Mounting evidence highlights the adverse effects of opioids. In spite of this, clinicians often prescribe excessive number of discharge opioids. . . In addition, discharge opioids contribute to prolonged opioid use; the proportion of patients (previously not on opioids) still consuming opioids 3 months after hospital discharge is 10.4%. At 6 months, the proportion is 4.4%. Unintentional chronic opioid use is associated with pre-operative opioid use, history of substance use, specific comorbidities, and invasive surgical procedures.”

Pain management at the emergency room

In an August 2019 study (2) of 2762 patients, researchers found a 90-day emergency room visit rate of 9.4%. At one center, 70% presented due to pain or medical concerns at nine days for pain and seven day post discharge for medical concerns, respectively. Independent risk factors for day emergency room visits included younger age, preoperative opioid use, chronic obstructive pulmonary disorder, and more vertebral levels involved.

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