Predictors of Long-Term Opioid Use Among Patients With Painful Lumbar Spine Conditions

Erin E. Krebs*, Jon D. Lurie, Gilbert Fanciullo, Tor D. Tosteson, Emily A. Blood, Timothy S. Carey, James Neil Weinstein

*Corresponding author for this work

Research output: Contribution to journalArticle

50 Scopus citations

Abstract

Our objective was to assess predictors of self-reported opioid use among patients with back pain due to lumbar disc herniation or spinal stenosis. Data were from the Spine Patient Outcomes Research Trial (SPORT), a multi-site observational study and randomized trial. We examined characteristics shown or hypothesized to be associated with opioid use. Using generalized estimating equations, we modeled associations of each potential predictor with opioid use at 12 and 24 months. At baseline, 42% of participants reported opioid use. Of these participants, 25% reported continued use at 12 months and 21% reported use at 24 months. In adjusted models, smoking (RR = 1.9, P < .001 at 12 months; RR = 1.5, P = .043 at 24 months) and nonsurgical treatment (RR = 1.7, P < .001 at 12 months; RR = 1.8, P = .003 at 24 months) predicted long-term opioid continuation. Among participants not using opioids at baseline, incident use was reported by 8% at 12 months and 7% at 24 months. We found no significant predictors of incident use at 12 or 24 months in the main models. In conclusion, nonsurgical treatment and smoking independently predicted long-term continued opioid use. To our knowledge, this is the first longitudinal study to assess predictors of long-term and incident opioid use among patients with lumbar spine conditions. Perspective: This longitudinal study of patients with disc herniation or spinal stenosis found that nonsurgical treatment and smoking predicted long-term self-reported opioid use. The greater risk of opioid continuation with nonsurgical therapy may be helpful in decision-making about treatment. The relationship between opioid use, smoking, and other substance use deserves further study.

Original languageEnglish (US)
Pages (from-to)44-52
Number of pages9
JournalJournal of Pain
Volume11
Issue number1
DOIs
StatePublished - Jan 2010

Keywords

  • back pain
  • disc herniation
  • opioid use
  • patient characteristics
  • spinal stenosis
  • surgery

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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