A Long-history of spine and neck pain and a long history of opioid use. What are the options?March 15, 2019
Patients who come into our office with long-histories of spine and neck pain also have a long history of opioid use. That they have been living on prescription painkillers for so long is one of the patient’s main concerns. It is also very difficult for them to see any other way to manage their problems.
Opioid use among long-term neck and back pain sufferers is a significant problem. More so for the sufferer. What can we do?
One suggestion comes from a study produced by United healthcare (1) in March 2019: In this study they say, too many opioid prescriptions are given that are not helpful. They call for a needed alternative for patients.
- “(this study) suggest a clinically and statistically significant increase in episode costs associated with opioid use for degenerative joint disease of the spine . . . and higher costs with a longer duration of opioid use as well as with higher daily dosages. Given the health consequences surrounding the overuse of opioids, concerted efforts to move towards a non-opioid pain control strategy are needed.
The suggestion is easy enough, find a way to offer non-opioid pain control strategies. However, for the pain sufferer easier said than done. Especially for those who use pain medications to help them manage AFTER pain surgery.
Extended use of painkillers after surgery
One of the greatest abuses of painkillers occurs after surgery. We see many spine and neck patients after minimally invasive procedures that did provide promised relief or has set them up for a more invasive fusion procedure, or has already sent them to fusion surgery.
Researchers writing in the medical journal Anesthesia & Analgesia (2) warn against theses abuses of prolonged pain-killer usage after surgery. They reported “Preoperative factors, including legitimate prescribed opioid use, self-perceived risk of addiction, and depressive symptoms each independently predicted more prolonged opioid use after surgery. Each of these factors was a better predictor of prolonged opioid use than postoperative pain duration or severity.”
What this research suggests is that the patients had perceived that they would be in great pain during the surgical recovery and that other factors including depression added to this fear. Opioid addiction came easily. Worse, as has been documented in many studies, prolonged opioid use after surgery makes healing challenging and difficult.
Especially among the older patients
Recently a study published in the Archives of Internal Medicine (3) suggesting that prescribing opioids for pain to older patients within seven days of short-stay surgery appears to be associated with long-term analgesic (pain-killer) use. The researchers suggested: Patients are frequently prescribed analgesics after ambulatory or short-stay surgery in anticipation of postoperative pain and the most common analgesics prescribed to outpatients are opioids (such as codeine and oxycodone) and nonsteroidal anti-inflammatory drugs (NSAIDS). While opioids can be beneficial, they are associated with such adverse effects as sedation, constipation and respiratory depression, and their long-term use can lead to physiologic tolerance and addiction, the authors write in their study background.
The doctors note that the prescription of codeine after short-stay surgery may contribute to the use of other potent opioids, such as oxycodone, which have been shown to be associated with increased morbidity and mortality. Further these points do not even consider that the continued use of opioids after one year raises the possibility that the exposure may result in addiction or physical dependence.
Especially among patients following head and neck surgery
A November 2018 report in the Journal of the American Medical Association (JAMA) (4) compared opioid use in patients who had major neck or head surgery in Hong Kong with patients getting similar procedures in the United States.
- “A significantly lower frequency of postoperative opioid orders was observed from Chinese University of Hong Kong compared with Oregon Health and Science University across similar major head and neck procedures. This contrast encourages a careful examination of:
- (1) cultural and patient expectations of pain control,
- (2) the metrics by which control is assessed,
- (3) industry and economic drivers of opioid use, and
- (4) alternatives to opioid pain regimens. A thoughtful shift in postoperative pain protocols that de-emphasizes opioid use may be an opportunity to counter the epidemic of opioid abuse in the United States.
As this study points out there is an expectation among doctors and patients that opioids will be needed following surgery. That is in the United States. In Hong Kong there is a different thought on the use of opioids, the are de-emphasized in the recovery process to avoid long-term use by the patient.
A different way and a different option – what can we do?
Chronic neck and back leads to problems of pain management including over-medication. If you have suffered from long-standing pain, chronic prolonged pain surgery and you want to explore ways of finding alternatives to opioid use, let’s explore the possibilities of regenerative medicine.
Using prolotherapy, Prolozone®, platelet rich plasma (PRP) and stem cell therapy, we accelerate and enhance the body’s natural healing process. We see many patients who have already been through the gamut of traditional medicine and have not found relief. Many people who have had no success with treatments such as surgery, nerve block, epidurals and steroid injections, trigger point injections, chiropractic therapy, acupuncture and more, find relief for the first time after receiving treatment at the Magaziner Center. With no side effects, downtime or surgery, we have gotten patients off of medication, helped them to avoid surgery and gotten them back to their lives.
1 Metfessel BA, Mentel MD, Phanel A, Dimartino MA, Allen M, Ho S. Opioid Use is Associated with Higher Severity-Adjusted Episode Costs in Patients with Conservatively Managed Degenerative Joint Disease of the Back and Neck. PharmacoEconomics. 2018 Dec 6:1-5.
2. Carroll I, Barelka P, Wang CK, et al. A Pilot Cohort Study of the Determinants of Longitudinal Opioid Use After Surgery. Anesth Analg. 2012 Jun 22.
3. Wolf MS et al (2012). Risk of unintentional overdose with non-prescription acetaminophen products. Journal of General Internal Medicine; DOI: 10.1007/s11606-012-2096-3
4 Li RJ, Li ML, Leon E, Ng CW, Shindo M, Manzione K, Andersen P, Clayburgh D, Wax M, Chan JY. Comparison of opioid utilization patterns after major head and neck procedures between Hong Kong and the United States. JAMA Otolaryngology–Head & Neck Surgery. 2018 Nov 1;144(11):1060-5.