Risk Factors for Continued Opioid Use in Conservative Versus Surgical Management of Low Back Pain Originating From the Sacroiliac Joint

Dengler, Julius; Sturesson, Bengt; Kools, Djaya; Prestamburgo, Domenico; Cher, Daniel; Eeckhoven, Eddie van; Erk, Emanuel; Gasbarrini, A.; Pflugmacher, Robert; Vajkoczy, Peter

doi:10.1177/2192568217733707

Cited by 8 publications

(5 citation statements)

References 33 publications

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“…Findings of these two reviews are therefore limited in generalizability to these LBP subgroups. Moreover, many primary studies have been published in this area since 2014 [37][38][39][40][41][42][43][44][45][46][47], particularly around disability, medication use, and surgical outcomes. A comprehensive and up-todate systematic review is needed to inform future research and practice, and improve health services delivery and quality of care for LBP.…”

Section: Introductionmentioning

confidence: 99%

The association between depressive symptoms or depression and health outcomes in adults with low back pain with or without radiculopathy: protocol of a systematic review

et al. 2019

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Background: A considerable proportion of adults with low back pain (LBP) suffer from depressive symptoms or depression. Those with depressive symptoms or depression may be at risk of poorer LBP recovery and require more health care. Understanding the role of prognostic factors for LBP is critically important to guide management and health services delivery. Our objective is to conduct a systematic review to assess the association between depressive symptoms or depression and health outcomes in adults with LBP with or without radiculopathy. Methods: Electronic databases including MEDLINE, Embase, CINAHL, and PsycINFO will be searched from inception to April 2019 to identify relevant studies. Additional citations will be identified by searching reference lists of included studies and related systematic reviews. Cohort and case-control studies assessing the association between depressive symptoms/ depression and health outcomes in adults aged 16 years and older with LBP with or without radiculopathy will be included. The following will be included: depressive symptoms as measured on standardized questionnaires (e.g., Center for Epidemiologic Studies Depression Scale, Beck Depression Index), and depression as standardized diagnoses (e.g., International Classification of Diseases codes) or self-reported depression diagnosis on standardized questionnaires. Outcomes of interest are standardized measures for pain, disability, overall health status, satisfaction with care, and health care utilization. These are informed by core outcome domains that international expert panels consider important for LBP research. Pairs of reviewers will screen articles retrieved from the search, extract data, and assess risk of bias using the Risk Of Bias In Non-randomized Studies-of Exposures (ROBINS-E) tool. Reviewers will use these criteria to inform their judgment on the internal validity of studies (e.g., low, moderate, or high risk of bias). If studies are deemed homogeneous, a random effects meta-analysis on the association between depressive symptoms and health outcomes will be performed. The results of the included studies will be descriptively outlined if studies are deemed heterogeneous. Discussion: The impact of depressive symptoms and depression on health-and health care-related outcomes for LBP with or without radiculopathy will be assessed and quantified. Findings of this systematic review will advance our understanding of LBP prognosis, and guide decision-making and improve quality of care for adults with LBP. Systematic review registration: PROSPERO CRD42019130047

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Section: Introductionmentioning

confidence: 99%

The association between depressive symptoms or depression and health outcomes in adults with low back pain with or without radiculopathy: protocol of a systematic review

et al. 2019

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“…Preoperative opioid use, preoperative depression and anxiety, smoking, Black race, more levels fused have been previously identified as risk factors for postoperative depression and anxiety and prolonged opioid use after spine surgery. 21,[28][29][30] Based on the results of this study, patients with concomitant lower extremity arthritis are at 20% to nearly 34% increased relative risk of postoperative depression, anxiety, and prolonged opioid use, suggesting that this must be considered as a notable risk factor for postoperative mental health disorders and chronic opioid use.…”

Section: Discussionmentioning

confidence: 99%

Lower Extremity Osteoarthritis: A Risk Factor for Mental Health Disorders, Prolonged Opioid Use, and Increased Resource Utilization After Single-Level Lumbar Spinal Fusion

Turcotte¹,

King²,

Patton³

2022

JAAOS Glob Res Rev

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Introduction: Few studies have examined the effect of hip or knee osteoarthritis, together described as lower extremity osteoarthritis (LEOA) on patient outcomes after lumbar fusion. The purpose of this study was to evaluate the effect of LEOA on postoperative outcomes and resource utilization in patients undergoing single-level lumbar fusion. Methods: Using a national deidentified database, TriNetX, a retrospective observational study of 17,289 patients undergoing single-level lumbar fusion with or without a history of LEOA before September 1, 2019, was conducted. The no-LEOA and LEOA groups were propensity score matched, and 2-year outcomes were compared using univariate statistical analysis. Results: After propensity score matching, 2289 patients with no differences in demographics or comorbidities remained in each group. No differences in the rate of repeat lumbar surgery were observed between groups (all P > 0.30). In comparison with patients with no LEOA, patients with LEOA experienced higher rates of overall and new onset depression or anxiety, prolonged opioid use, hospitalizations, emergency department visits, and ambulatory visits over the 2-year postoperative period (all P < 0.02). Conclusion: Patients with LEOA undergoing single-level lumbar fusion surgery are at higher risk for suboptimal outcomes and increased resource utilization postoperatively. This complex population may benefit from additional individualized education and multidisciplinary management.

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“…A recent study by Dengler et al noted similar opioid consumption in patients with SIJ dysfunction (52.5%). Opioid consumption remained the same in the conservatively treated patients (46.9%), while it significantly decreased following MISJF (57.7–44.2%) [ 12 ]. For comparison, opioid consumption in patients with knee or hip osteoarthritis is reported to be around 23.6% [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Double-center observational study of minimally invasive sacroiliac joint fusion for sacroiliac joint dysfunction: one-year results

et al. 2022

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Background For a substantial part of patients with chronic low back pain, the origin is located in the sacroiliac joint (SIJ). Minimally invasive sacroiliac joint fusion (MISJF) is increasingly being implemented as a treatment option in SIJ dysfunction. Despite remaining controversy, evidence continues to increase. This study evaluates the clinical results and safety of MISJF in a double-center consecutive case series in patients with SIJ dysfunction over a one-year observation period. Methods SIJ complaints were diagnosed after history taking, physical examination and least a 50% reduction of SIJ pain 30–60 min following image-guided injection. Primary outcome measures were patient reported outcome measurements (PROMs), consisting of Visual Analogue Scale (VAS) pain score and EuroQol 5-dimensions 3-levels (EQ-5D-3L). Patients’ perspectives on the effects of surgery were collected through questionnaires. Secondary outcome measures were implant positioning and (serious) adverse events ((S)AE’s). Results A total of 29 patients were included. In 44.8% of patients, SIJ dysfunction was of postpartum origin. The mean VAS-pain score improved from 7.83 (± 1.71) to 4.97 (± 2.63) postoperatively (p < 0.001). EQ-5D-3L score improved from 0.266 (± 0.129) to 0.499 (± 0.260) postoperatively (p < 0.001). Opioid consumption decreased from 44.8 to 24.1% postoperatively (p = 0.026). In 13.7% of patients, an (S)AE occurred. Conclusion MISJF appears to be an effective and safe procedure in this cohort. Statistically significant and clinically relevant improvements in pain and quality of life were observed one-year postoperatively. Future studies should focus on the long-term outcomes to further evaluate the safety and effectiveness of MISJF.

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Risk Factors for Continued Opioid Use in Conservative Versus Surgical Management of Low Back Pain Originating From the Sacroiliac Joint

Cited by 8 publications

References 33 publications

The association between depressive symptoms or depression and health outcomes in adults with low back pain with or without radiculopathy: protocol of a systematic review

The association between depressive symptoms or depression and health outcomes in adults with low back pain with or without radiculopathy: protocol of a systematic review

Lower Extremity Osteoarthritis: A Risk Factor for Mental Health Disorders, Prolonged Opioid Use, and Increased Resource Utilization After Single-Level Lumbar Spinal Fusion

Double-center observational study of minimally invasive sacroiliac joint fusion for sacroiliac joint dysfunction: one-year results

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