Initial Provider Specialty Is Associated With Long-term Opiate Use in Patients With Newly Diagnosed Low Back and Lower Extremity Pain

Azad, Tej D.; Vail, Daniel; Bentley, Jason; Han, Summer S.; Suárez, Paola; Varshneya, Kunal; Mittal, Vaishali; Veeravagu, Anand; Desai, Manisha; Bhattacharya, Jay; Ratliff, John K.

doi:10.1097/brs.0000000000002840

Cited by 25 publications

(35 citation statements)

References 30 publications

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“…Opiate-naive patients were defined as those who had not filled a prescription for opiates in the 6 months prior to diagnosis without accounting for days of supply. 19 As up to 40% of patients with LBP receive opiates within the first year of diagnosis, 19 this inclusion criterion was created to minimize the risk of misclassifying chronic LBP or LEP as a new diagnosis and exclude patients with chronic pain, for whom different management may be indicated. The initial visit, which served as a proxy for time of LBP or LEP onset, was defined as the first visit at which an enrollee had a claim with an ICD-9-CM (or ICD-10-CM ) code that met the criteria of LBP or LEP (eTable 1 in the Supplement) without any of these inclusion diagnoses in the 12 months prior to this visit.…”

Section: Methodsmentioning

confidence: 99%

Expenditures and Health Care Utilization Among Adults With Newly Diagnosed Low Back and Lower Extremity Pain

et al. 2019

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IMPORTANCE Low back pain (LBP) with or without lower extremity pain (LEP) is one of the most common reasons for seeking medical care. Previous studies investigating costs in this population targeted patients receiving surgery. Little is known about health care utilization among patients who do not undergo surgery. OBJECTIVES To assess use of health care resources for LBP and LEP management and analyze associated costs. DESIGN, SETTING, AND PARTICIPANTS This cohort study used a retrospective analysis of a commercial database containing inpatient and outpatient data for more than 75 million individuals.

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Section: Methodsmentioning

confidence: 99%

Expenditures and Health Care Utilization Among Adults With Newly Diagnosed Low Back and Lower Extremity Pain

et al. 2019

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“…Narcotic use is prevalent among patients with degenerative pathology of the lumbar spine and especially so among those who eventually undergo spinal surgery [2,3]. Although narcotic medications may provide short- Calculated using t-test to compare intergroup differences.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Preoperative Narcotic Consumption on Patient-Reported Outcomes of Lumbar Decompression

et al. 2022

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This study aimed to assess the relationship between preoperative narcotic consumption and patient-reported outcomes (PRO) in patients undergoing minimally invasive (MIS) lumbar decompression (LD). Overview of Literature: Previous studies report negative effects of narcotic consumption on perioperative outcomes and recovery; however, its impact on quality of life and surgical outcomes is not fully understood. Methods: A surgical database was retrospectively reviewed for patients undergoing primary, single-level MIS LD from 2013 to 2020. Patients lacking preoperative narcotic consumption data were excluded. Demographics, spinal pathologies, and operative characteristics were collected. Patients were grouped based on preoperative narcotic consumption. Patient Health Questionnaire-9 (PHQ-9), Visual Analog Scale (VAS) for back and leg, Oswestry Disability Index (ODI), 12-item Short Form Physical Component Summary, and Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF) were collected preoperatively and postoperatively. Preestablished values were used to calculate achievement of minimum clinically important difference (MCID). Differences in mean PROs and MCID achievement between groups were evaluated. Results: The cohort was 453 patients; 184 used preoperative narcotics and 269 did not. Significant differences were found in American Society of Anesthesiologists classification, ethnicity, insurance type, and estimated blood loss between groups. Significant differences were also found in preoperative PHQ-9, VAS leg, ODI, and PROMIS-PF between groups (all p<0.05). Mean postoperative PROs did not differ by group (p>0.05). A higher rate of MCID achievement was associated with the narcotic group for PHQ-9 and PROMIS-PF at 6 weeks (both p≤0.050), VAS leg at 1 year (p=0.009), and overall for ODI and PHQ-9 (both p≤0.050). Conclusions: Preoperative narcotic consumption was associated with worse preoperative depression, leg pain, disability, and physical function. In patients consuming preoperative narcotics, a higher proportion achieved an overall MCID for disability and depressive symptoms. Patients taking preoperative narcotic medications may report significantly worse preoperative PROs but demonstrate greater improvements in postoperative disability and mental health.

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“…Patients with newly-diagnosed LBP or LEP, defined as those without another diagnosis code indicating LBP or LEP in the 12 months prior to initial diagnosis, were identified from the IBM MarketScan Database (Supplementary Table 1) [8][9][10]. The index diagnosis date refers to the first inpatient or outpatient diagnosis of LBP or LEP for a given enrollee.…”

Section: Cohort Selectionmentioning

confidence: 99%

“…The index surgery date refers to the first date on which a surgical code for LBP or LEP was listed during the period of post-diagnosis follow-up. Total cumulative dose in morphine milligram equivalents (MMEs) was derived based on conversion guidelines established by the Centers for Disease Control and Prevention, as described in our prior studies [10,11]. The CONSORT diagram corresponding to study cohort identification is depicted in Supplementary Figure 1.…”

Section: Cohort Selectionmentioning

confidence: 99%

Defining and describing treatment heterogeneity in new-onset idiopathic lower back and extremity pain through reconstruction of longitudinal care sequences

et al. 2021

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Initial Provider Specialty Is Associated With Long-term Opiate Use in Patients With Newly Diagnosed Low Back and Lower Extremity Pain

Abstract: 3.

Cited by 25 publications

References 30 publications

Expenditures and Health Care Utilization Among Adults With Newly Diagnosed Low Back and Lower Extremity Pain

Expenditures and Health Care Utilization Among Adults With Newly Diagnosed Low Back and Lower Extremity Pain

The Influence of Preoperative Narcotic Consumption on Patient-Reported Outcomes of Lumbar Decompression

Defining and describing treatment heterogeneity in new-onset idiopathic lower back and extremity pain through reconstruction of longitudinal care sequences

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