Early Opioid Prescription and Subsequent Disability Among Workers With Back Injuries

Franklin, Gary M.; Stover, Bert; Turner, Judith A.; Fulton‐Kehoe, Deborah; Wickizer, Thomas M.

doi:10.1097/brs.0b013e318160455c

Cited by 194 publications

(151 citation statements)

References 18 publications

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“…Subsequent epidemiologic studies report similar findings [41,42]. A large body of literature now exists, demonstrating low levels of return to work for injured workers treated with opioids relative to those not receiving opioids [43][44][45][46][47]. Evidence is accumulating that patients treated with opioids who remain on the treatment for more than 90 days are likely to dose-escalate and are unlikely to discontinue the therapy [48,49].…”

Section: Effectivenessmentioning

confidence: 62%

“Safe and Effective When Used As Directed”: The Case of Chronic Use of Opioid Analgesics

Ballantyne

2012

J. Med. Toxicol.

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Opioid analgesics have been used increasingly over the past 20 years for the management of chronic noncancer pain in the USA under the assumption that they were safe and effective when used as directed. The accuracy of that assumption has not been tested against accumulated evidence. The safety of opioids used on a long-term basis has not been tested in clinical trials. Epidemiologic evidence from examinations of such use in the general population indicates that the risk of overdose increases in a doseresponse manner. Such evidence also suggests increased risk of fractures and acute myocardial infarctions among elderly users of opioids for chronic pain. Experimental evidence supports short-term use of opioids, but trials of long-term use for chronic pain have not been conducted. Epidemiologic evidence suggests that long-term use does not result in improvement in function or quality of life while being associated with significant dropout rates and a high prevalence of adverse drug effects. Substantial fractions of patients are not using opioid analgesics as directed, while millions of US residents are using them without a prescription for nonmedical reasons. A prudent treatment approach consistent with the available evidence would be to reserve chronic opioid therapy for serious pain-related problems for which the effectiveness of opioids has been demonstrated and for patients whose use as directed is assured through close monitoring and for whom an explicit, informed calculation has been made that the benefits of opioids outweigh the risks.

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Section: Effectivenessmentioning

confidence: 62%

“Safe and Effective When Used As Directed”: The Case of Chronic Use of Opioid Analgesics

Ballantyne

2012

J. Med. Toxicol.

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“…60 Two recent publications have documented that the use of opioids within the WC setting, for both acute and chronic back pain, is significantly associated with increased risk for work disability at one-year. 44,[61][62][63] While surgical patients from this patient population have been identified as having increased rates of post-rehabilitation healthcare utilization, 64 the increased treatment seeking by patients may be in the service of maintaining their opioid dependence. 63 Further support for this hypothesis comes from the fact that data on more recent 2010-11 outcomes has seen the treatment seeking from new healthcare providers decrease 60-80% into the single digits (as measured on a quarterly basis), possibly due to more effective pain medication management and patient-negotiated opioid tapering.…”

Section: Discussionmentioning

confidence: 99%

“…[59][60][61][62] However, few studies focus on (or even include) WC claim patients. With the exception of two studies, 41,59 no other previous studies have looked at a population of extreme lengths of disability after WC claims receiving one or more fusions or other spinal procedure in a continuum of care (i.e., surgery followed by active rehabilitation).…”

Section: Discussionmentioning

confidence: 99%

Lumbar Surgery in Work-Related Chronic Low Back Pain: Can a Continuum of Care Enhance Outcomes?

Mayer

Gatchel

Brede³

et al. 2013

The Spine Journal

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Background Context-Systematic reviews of lumbar fusion outcomes in purely workers' compensation (WC) patient populations have indicated mixed results for efficacy. Recent studies on lumbar fusions in the WC setting have reported return-to-work rates of 26-36%, re-operation rates of 22-27%, and high rates of persistent opioid use two years post-surgery. Other types of lumbar surgery in WC populations are also acknowledged to have poorer outcomes than in non-WC. The possibility of improving outcomes by employing a biopsychosocial model with a continuum of care, including post-operative functional restoration in this "at risk" population, has been suggested as a possible solution.

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“…Franklin and his colleagues examined whether prescription of opioids within 6 weeks of low back injury was associated with work disability at 1 year [49]. They found that more than one third of the workers received an opioid prescription within the first six weeks, with about 50% received at the first medical visit.…”

Section: Opioids and Disabilitymentioning

confidence: 99%

Prescription Opioid Medications: Efficacy in Chronic Pain

Miller¹,

Oberbarnscheidt²

2017

J Addict Res Ther

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Early Opioid Prescription and Subsequent Disability Among Workers With Back Injuries

Abstract: Prescription of opioids for more than 7 days for workers with acute back injuries is a risk factor for long-term disability. Further research is needed to elucidate this association.

Cited by 194 publications

References 18 publications

“Safe and Effective When Used As Directed”: The Case of Chronic Use of Opioid Analgesics

“Safe and Effective When Used As Directed”: The Case of Chronic Use of Opioid Analgesics

Lumbar Surgery in Work-Related Chronic Low Back Pain: Can a Continuum of Care Enhance Outcomes?

Prescription Opioid Medications: Efficacy in Chronic Pain

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