The statistics are jarring: back pain is something that will affect 8 out of 10 people at some point in their lives, representing the vast majority of people in the United States.
Though some pain is fleeting, for many it becomes chronic and relentless, driving them to the use of powerful painkillers, including opioids. As the national opioid epidemic continues to grow, with overdoses killing more than 42,000 people in 2016, spine surgeons have found themselves in the dilemma of being uncertain as to how to address pain management for their surgical patients.
A just-released study published in the Journal of Neurosurgery: Spine and conducted by the Department of Neurological Surgery at the University of Louisiana provides them with some reassuring news, concluding that when back pain patients diagnosed with degenerative spondylolisthesis undergo decompression and fusion surgery, their use of opioids actually decreases.
Opioid use is a problem everywhere, but in the state of Kentucky, where the University of Louisville is based, it is a particular concern: the state has the fifth highest rate of overdose deaths in the country.
The drugs are generally prescribed by well-intentioned physicians as a means of pain management in the face of all types of injuries, and once patients become addicted the habit is extremely difficult to break. When patients suffering from back pain seek a consultation with a spine specialist, it is generally after having already attempted to address their problem with the help of their family doctor.
According to Mayur Sharma, M.D., M.Ch., a resident at the hospital who led the study, patients have often been prescribed opioids already, and may already be hooked. “Spine surgery patients deal with an immense amount of pain both before and after surgery. Opioids are used to manage that pain,” he said. He and colleagues set out to determine whether spine surgery decreased or increased opioid use.
The study looked at the period between 2000 and 2012, during which time there were 10,708 patients treated for a condition known as degenerative spondylolisthesis.
This is an extremely painful condition in which nerves in the spinal cord are compressed as a result of one vertebra slipping over another. A review of patient medical records revealed that prior to surgery 14.85 percent of patients were or had been dependent on opioid pain medications at some point in the year prior to the surgery, and after surgery that number dropped to 9.9 percent, representing a reduction of nearly 5 percent.
Discussing the results, Sharma said, “Patients have been abusively using opioids for pain resulting in the recently declared national opioid crisis. Our work indicates that surgery for degenerative spondylolisthesis is associated with a reduced risk of opioid dependence.”
The study also revealed that those who are at greatest risk for dependence are those who are younger or who were previously dependent upon opioids.