The dangers of opioids have been well documented recently, with numerous news stories, documentaries, state legislative changes and even a promise of changes from the federal government level.
We all know these drugs can be dangerous; the data on addiction and overdose deaths is frightening and overwhelming. What we hear less about is the impact these drugs have on outcomes in musculoskeletal disorders, particularly in Workers’ Compensation cases. Forgetting about the hazards these drugs bring about, what is their impact on a patient’s ability to return to work after a commonly performed surgery such as a lumbar discectomy? A recently published article in Spine Journal examined exactly this set of circumstances, and the results were not favorable for patients that were prescribed opioids preoperatively.
The study identified 712 patients that had received a lumbar discectomy in a workers’ compensation claim and organized the patients into groups that either received no opioids preoperatively or groups that had short term, moderate term or long term opioid use preoperatively. There was a significant difference in rates of return Return to Work between the non-opioid group (64.1%) and the moderate term (52.7%) and chronic opioid (36.9%) use patients. In addition to poor Return to Work, there was also a strong correlation between long term opioid use and higher overall medical costs, psychiatric illness, failed back surgery syndrome and the need for postsurgical opioid use.
The authors concluded that avoiding using opioids or at most using them in a very short term course will help lead to a better outcome in a workers’ comp lumbar discectomy, all while avoiding the additional negative ramifications associated with the use of opioid medications.
These results are not surprising based on what we know about opioid induced analgesia, where patients taking opioids can have an altered sensitivity to pain, even experiencing pain in situations previously that would not have been painful. This is just further evidence that opioids should be used very cautiously when necessary and over a short course of treatment. It is likely the findings in this study could be extrapolated into other musculoskeletal conditions, even when not involving a surgical intervention. More conservative methods such as Physical Therapy have been demonstrated to be a more safe and effective method to manage pain.
To find out more about this article, you can locate the abstract here https://goo.gl/uVocZA
