More Than 1 in 3 Patients With Chronic Low Back Pain Continue to Use Opioids Long-term After Spinal Fusion

Abstract

Objective: A common expectation for patients after elective spine surgery is that the procedure will result in pain reduction and minimize the need for pain medication. Most studies report changes in pain and function after spine surgery, but few report the extent of opioid use after surgery. This systematic review aims to identify the rates of opioid use after lumbar spine fusion.Materials and Methods: PubMed, CINAHL, Cochrane Central Register of Controlled Trials, and Ovid Medline were searched to identify studies published between January 1, 2005 and June 30, 2020 that assessed the effectiveness of lumbar fusion for the management of low back pain.Results: Of 6872 abstracts initially identified, 329 studies met the final inclusion criteria, and only 32 (9.7%) reported any postoperative opioid use. Long-term opioid use after surgery persists for more than 1 in 3 patients with usage ranging from 6 to 85.9% and a pooled mean of 35.0% based on data from 21 studies (6.4% of all lumbar fusion studies).Discussion: Overall, opioid use is not reported in the majority of lumbar fusion trials. Patients may expect a reduced need for opioidbased pain management after surgery, but the limited data available suggests long-term use is common. Lack of consistent reporting of these outcomes limits definitive conclusions regarding the efficacy of spinal fusion for reducing long-term opioid. Patient decisions about undergoing surgery may be altered if they had realistic expectations about rates of postsurgical opioid use. Spine surgery trials should track opioid utilization out to a minimum of 6 months after surgery as a core outcome.

Psychedelic-Assisted Therapy and Psychedelic Science: A Review and Perspective on Opportunities in Neurosurgery and Neuro-Oncology

“…46,79,110,111 For example, in spine surgery candidates, given that smoking is associated with lower fusion rates, and psilocybin-assisted therapy has shown promise in early trials for nicotine and opioid addiction, PAT could be considered preoperatively to improve fusion rates and to reduce opioid dependence postsurgery which may occur in up to 1/3 of such patients. 6,45,100,112,113 RUMINATIVE DISORDERS, SUD, AND PTSD BEING TARGETED WITH NEUROMODULATION DBS and TMS have both shown variable efficacy or been considered for treating OCD, anorexia, SUD, depression, and PTSD. [72][73][74][114][115][116][117][118][119] DBS which stereotactically targets focal nuclei and TMS which focally targets broader brain regions contrasts with the global approach of ingesting a 5-HT 2A -R agonist to more broadly alter neural networks.…”

“…NA, not available; SUD, substance use disorders.aSUD includes for alcohol, opioids, and/or nicotine.Refer to references: 76-104 .…”

“…As shown in Table 2, potential targets for PAT are the depression, anxiety, and SUD that are common, under-reported, and often undertreated in patients with brain tumors, stroke, SAH, TBI, spinal cord injury, chronic spinal disability, other pain syndromes, and Parkinson disease. 3,4,76-104 For example, psilocybin-assisted therapy may help some of these patients gain greater acceptance of their disability, reduce apathy, and promote living more fully. 82,83…”

Self-Movement Screening using the Symmio Application is Reliable and Valid for Identifying Musculoskeletal Risk Factors

“…1 Poor MSK health can cause significant loss of time from work and recreational activities, and it is strongly correlated with the development of chronic pain syndrome and opioid use. 2 According to data from the World Health Organization, MSK health problems are second only to mental health disorders as the primary contributor to years of life with disability and 19 th in years of life lost across the globe. 3 Over a 15-year period, the total number of years living with disability due to MSK conditions has increased from 77 million to 103 million and years of life loss have risen by more than 40 percent.…”

Nucleus Disc Replacement: Design and Material Selection FEA Analysis

“…Te standard treatment for these cases is a discectomy, frequently followed by spinal arthrodesis. In both events, the index level undergoes biomechanical changes that cause arthritic changes in this level [2] and adjacent ones [3]. Terefore, the best approach would be to replace the function of the damaged intervertebral discs.…”