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Differences in patient-reported outcomes in spine surgery patients on opioids prior to surgery: preliminary findings from international PAIN-OUT postoperative pain registry

      Excellent pain control is difficult to achieve following major spine surgery. Suboptimal postoperative pain control may delay recovery, extend the hospital stay, increase medical costs, increase rate of complications, lead to development of chronic pain, and contribute to poor patient satisfaction. Patients on opioid treatment prior to surgery represent a unique challenge. We investigated differences in pain treatment patterns and patient reported outcomes in spine surgery patients with and without opioid therapy prior to surgery from the international PAIN-OUT registry (www.pain-out.eu). Data includes medical record information and self-reported patient outcomes using the International Pain Outcome (IPO) survey from Europe, North America, South America, Asia and Africa. Of 1039 spine surgery patients enrolled between June 30, 2010 and October 5, 2012, 918 with available data on prior opioid use were examined. On admission 222 (24%) were on some type of opioid regimen. There were no significant differences between groups for age, gender, or length of surgery. Patients on opioids prior to admission reported more postoperative pain (worst pain 7.2/10 vs. 5.9, least 3.2 vs. 2.3; amount of time in severe pain 41% vs. 33%; p = <0.001), and felt more anxious, depressed and helpless. Those on opioids prior to admission also reported more pain interference with postop activities (in bed 6.4 vs. 5.1, out of bed 5.1 vs. 4.0; p = <0.001), falling asleep (5.3 vs. 3.6, p = .02), and were less satisfied with results of pain treatment (7.5 vs. 8.0, p = 005) though clinical significance is debatable. Significant differences in worse pain, time in severe pain and in bed activities interference appear present for patients who received ketamine though sample sizes for this group are small. Findings will be used to form a local quality improvement initiative focused on optimizing multimodal treatment.