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Volume 11, Issue 1, Pages 44-52 (January 2010)


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

Erin E. KrebsCorresponding Author Informationemail address, Jon D. Lurie, Gilbert Fanciulloδ, Tor D. Tosteson, Emily A. Blood, Timothy S. Carey, James N. Weinstein

Received 29 January 2009; received in revised form 4 May 2009; accepted 28 May 2009. published online 23 July 2009.

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.

 Center on Implementing Evidence-Based Practice, Roudebush VA Medical Center; Department of Medicine, Indiana University School of Medicine; and Regenstrief Institute, Inc, Indianapolis, Indiana

 Department of Medicine, Dartmouth Medical School, Hanover, New Hampshire

 Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire

δ Department of Anesthesiology, Dartmouth Medical School, Hanover, New Hampshire

 Department of Orthopaedics, Dartmouth Medical School, Hanover, New Hampshire

 Cecil G. Sheps Center for Health Services Research, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina

Corresponding Author InformationAddress reprint requests to Dr Erin E. Krebs, Roudebush VA (11H), 1481 W 10th Street, Indianapolis, IN 46202.

 Supported by grant U01-AR45444-01A1 from NIAMS and by the NIH Office of Research on Women's Health and NIOSH, Centers for Disease Control and Prevention. Dr Krebs was supported by a VA HSR & D Research Career Development Award.

PII: S1526-5900(09)00569-0

doi:10.1016/j.jpain.2009.05.007


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