Associations Between Early Care Decisions and the Risk for Long-term Opioid Use for Patients With Low Back Pain With a New Physician Consultation and Initiation of Opioid Therapy

Fritz, Julie M.; King, Jordan B.; McAdams-Marx, Carrie

doi:10.1097/ajp.0000000000000571

Cited by 32 publications

(23 citation statements)

References 47 publications

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“…The aim of this study was to derive a CPR to identify patients who might be more likely to become chronic users of prescription opioids after orthopedic hip surgery. While other studies have utilized prescription data to define chronic opioid use (Fritz et al 2018 ; Sites et al 2018 ; Thackeray et al 2017 ), this study is the first to develop a clinical prediction rule based on opioid prescription patterns validated from pharmacy data in claims records. The focus of our investigation was to better understand variables that may improve clinical decision-making related to managing patients that are taking opioids after surgery and at the same time generate hypotheses for future trials.…”

Section: Discussionmentioning

confidence: 99%

Predictors of chronic prescription opioid use after orthopedic surgery: derivation of a clinical prediction rule.

et al. 2018

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BackgroundPrescription opioid use at high doses or over extended periods of time is associated with adverse outcomes, including dependency and abuse. The aim of this study was to identify mediating variables that predict chronic opioid use, defined as three or more prescriptions after orthopedic surgery.MethodsIndividuals were ages between 18 and 50 years and undergoing arthroscopic hip surgery between 2004 and 2013. Two categories of chronic opioid use were calculated based on individuals (1) having three or more unique opioid prescriptions within 2 years and (2) still receiving opioid prescriptions > 1 year after surgery. Univariate elationships were identified for each predictor variable, then significant variables (P > 0.15) were entered into a multivariate logistic regression model to identify the most parsimonious group of predictor variables for each chronic opioid use classification. Likelihood ratios were derived from the most robust groups of variables.ResultsThere were 1642 participants (mean age 32.5 years, SD 8.2, 54.1% male). Nine predictor variables met the criteria after bivariate analysis for potential inclusion in each multivariate model. Eight variables: socioeconomic status (from enlisted rank family), prior use of opioid medication, prior use of non-opioid pain medication, high health-seeking behavior before surgery, a preoperative diagnosis of insomnia, mental health disorder, or substance abuse were all predictive of chronic opioid use in the final model (seven variables for three or more opioid prescriptions; four variables for opioid use still at 1 year; all< 0.05). Post-test probability of having three or more opioid prescriptions was 93.7% if five of seven variables were present, and the probability of still using opioids after 1 year was 69.6% if three of four variables were present.ConclusionA combination of variables significantly predicted chronic opioid use in this cohort. Most of these variables were mediators, indicating that modifying them may be feasible, and the potential focus of interventions to decrease the risk of chronic opioid use, or at minimum better inform opioid prescribing decisions. This clinical prediction rule needs further validation.

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Section: Discussionmentioning

confidence: 99%

Predictors of chronic prescription opioid use after orthopedic surgery: derivation of a clinical prediction rule.

et al. 2018

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“…This table only includes predictor variables that were in more than one model. Studies with opioid-naïve sample37,[39][40][41]64,66,71 Results from Koeppe 2011 are not included because the definition of opioid-naïve sample differed from the other studies. 73 a…”

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confidence: 99%

Long‐term opioid therapy definitions and predictors: A systematic review

Karmali

Bush

Raman

et al. 2019

Pharmacoepidemiology and Drug

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Purpose This review sought to (a) describe definitions of long‐term opioid therapy (LTOT) outcome measures, and (b) identify the predictors associated with the transition from short‐term opioid use to LTOT for opioid‐naïve individuals. Methods We conducted a systematic review of the peer‐reviewed literature (January 2007 to July 2018). We included studies examining opioid use for more than 30 days. We classified operationalization of LTOT based on criteria used in the definitions. We extracted LTOT predictors from multivariate models in studies of opioid‐naïve individuals. Results The search retrieved 5,221 studies, and 34 studies were included. We extracted 41 unique variations of LTOT definitions. About 36% of definitions required a cumulative duration of opioid use of 3 months. Only 17% of definitions considered consecutive observation periods, 27% used days' supply, and no definitions considered dose. We extracted 76 unique predictors of LTOT from seven studies of opioid‐naïve patients. Common predictors included pre‐existing comorbidities (21.1%), non‐opioid prescription medication use (13.2%), substance use disorders (10.5%), and mental health disorders (10.5%). Conclusions Most LTOT definitions aligned with the chronic pain definition (pain more than 3 months), and used cumulative duration of opioid use as a criterion, although most did not account for consistent use. Definitions were varied and rarely accounted for prescription characteristics, such as days' supply. Predictors of LTOT were similar to known risk factors of opioid abuse, misuse, and overdose. As LTOT becomes a central component of quality improvement efforts, researchers should incorporate criteria to identify consistent opioid use to build the evidence for safe and appropriate use of prescription opioids.

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“…Fritz et al 19 found an increased risk of long-term opioid use with primary care versus physical therapy visits following a new consultation for lower back pain. Although infrequently used, PT incorporates nonpharmacologic pain management strategies including exercises, spinal manipulation, and education to improve CLBP.…”

Section: Discussionmentioning

confidence: 99%

“…Although infrequently used, PT incorporates nonpharmacologic pain management strategies including exercises, spinal manipulation, and education to improve CLBP. 19 - 21 Several studies 19 , 22 , 23 suggest early use of PT are associated with lower CLBP-related costs and reduced use of MRI, spinal injections, and opioid use. While this study did not focuse on the CLBP-related costs and use of other services, PT did reduce the use of nonopioid and opioid medications.…”

Section: Discussionmentioning

confidence: 99%

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Does early physical therapy intervention reduce opioid burden and improve functionality in the management of chronic lower back pain?

Martin

Tallian²,

Nguyen

et al. 2020

Mental Health Clinician

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Abstract Introduction Chronic lower back pain is a leading cause of disability in US adults. Opioid use continues to be controversial despite the Centers for Disease Control and Prevention guidance on chronic pain management to use nonpharmacologic and nonopioid pharmacologic interventions. The objectives of the study were to assess the impact of early physical therapy (PT) intervention on improving functionality and reducing opioid burden in patients with chronic lower back pain. Methods A single-center, retrospective chart review of patients receiving ≥6 PT visits and treated with either opioids first (OF) or PT first (PTF) therapy for chronic lower back pain were evaluated. Concomitant use of nonopioid and nonpharmacologic therapy was permitted. The Oswestry Disability Index (ODI), a survey measuring functionality, was recorded for PTF group. Pain scores and medication use including opioids were collected at treatment initiation and completion. Results One hundred and eighty patients were included in three groups: OF group (n = 60), PTF group (n = 60), and PTF + ODI group (n = 60). The PTF + ODI group had mean ODI reduction of 11.9% (P < .001). More OF patients were lost to follow up (68.3%) or failed PT (60%) compared to the PTF group, 38.3% and 3.3% (P < .001). Reduction in both opioid and nonopioid medications as well as pain scores were observed but not statistically significant. Discussion Early PT resulted in improved functionality, decreased pain, and reduced medication use upon PT completion. These findings suggest PT, along with nonopioid modalities, are a viable first-line option for the management of chronic lower back pain.

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Associations Between Early Care Decisions and the Risk for Long-term Opioid Use for Patients With Low Back Pain With a New Physician Consultation and Initiation of Opioid Therapy

Cited by 32 publications

References 47 publications

Predictors of chronic prescription opioid use after orthopedic surgery: derivation of a clinical prediction rule.

Predictors of chronic prescription opioid use after orthopedic surgery: derivation of a clinical prediction rule.

Long‐term opioid therapy definitions and predictors: A systematic review

Does early physical therapy intervention reduce opioid burden and improve functionality in the management of chronic lower back pain?

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