A preoperative interdisciplinary biopsychosocial opioid reduction program in patients on chronic opioid analgesia prior to spine surgery: A preliminary report and case series

Scandinavian Journal of Pain - Tập 13 Số 1 - Trang 27-31 - 2016
Sameer Hassamal1,2, Margaret Haglund3, Karl Wittnebel4, Itai Danovitch3
1Department of Addiction Psychiatry , University of California Los Angeles/Kern Medical , Bakersfield, CA , United States
2Department of Psychiatry and Neurology , University of California Riverside , Riverside, CA , United States
3Department of Psychiatry and Behavioral Neurosciences , Cedars-Sinai Medical Center , Los Angeles, CA , United States
4Department of Internal Medicine , Cedars-Sinai Medical Center , Los Angeles, CA , United States

Tóm tắt

Abstract Background Spine surgery candidates are commonly treated with long-term opioid analgesia. However, chronic opioid analgesia is associated with poor pain control, psychological distress, decreased functional status and operative complications. Therefore, our medical centre piloted an outpatient biopsychosocial interdisciplinary opioid reduction program for spine surgery candidates on chronic opioid analgesia. Methods Our case series reviews the outcomes of the first 5 interdisciplinary program completers. Data was collected on admission to the program, preoperatively at completion of the program, and 1 month postoperatively. We recorded changes in pain interference scores, physical functioning, and symptoms of depression and anxiety as captured by the Patient-Reported Outcome Measurement Information System (PROMIS-29) Profile. Results The mean duration of the preoperative opioid reduction program was 6–7 weeks. The mean morphine equivalent daily dose (SD) decreased from 238.2 (226.9) mg on admission to 157.1 (161.0) mg preoperatively and 139.1 (84.0) mg one month postoperatively. Similarly, the mean pain interference score (SD) decreased from 72.4 (5.1) on admission to 66.5 (6.9) preoperatively and 67.7 (5.4) one month postoperatively. The preoperative opioid dose and pain interference scores decreased in all 5 patients, but one month postoperatively increased in one patient related to a surgical complication. Pre- and postoperative depression, anxiety and fatigue improved in all patients. Satisfaction with participation in social roles, sleep disturbances, and physical functioning improved in most patients. Conclusions Pre- and post-operative pain improved despite the opioid dose being tapered. These preliminary data suggest that a short-term outpatient preoperative interdisciplinary biopsychosocial opioid reduction program is safe, feasible, and improves patient-centred outcomes. Implications Our preliminary data support the rationale for expansion of the opioid reduction program; opioid use and pain should be evaluated in all surgical candidates. These findings need to be replicated in larger studies.

Từ khóa


Tài liệu tham khảo

Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 2006;10:287–333.

Goral A, Lipsitz JD, Gross R. The relationship of chronic pain with and without comorbid psychiatric disorder to sleep disturbance and health care utilization: results from the Israel National Health Survey. J Psychosom Res 2010;69:449–57.

Gaskin DJ, Richard P. The economic costs of pain in the United States. J Pain 2012;13:715–24.

Centers for Disease Control and Prevention. Vital signs: overdoses of prescription opioid pain relievers – United States, 1999–2008. MMWR Morb Mortal Wkly Rep 2011;60:1487–92.

NIH. Pathways to prevention workshop: the role of opioids in the treatment of chronic pain; 2014.

Wasan AD, Michna E, Edwards RR, Katz JN, Nedeljkovic SS, Dolman AJ, Janfaza D, Isaac Z, Jamison RN. Psychiatric comorbidity is associated prospectively with diminished opioid analgesia and increased opioid misuse in patients with chronic low back pain. Anesthesiology 2015;123:861–72.

Moulin DE, Iezzi A, Amireh R, Sharpe WK, Boyd D, Merskey H. Randomised trial of oral morphine for chronic non-cancer pain. Lancet 1996;347:143–7.

Hahn KL. Strategies to prevent opioid misuse: abuse, and diversion that may also reduce the associated costs. Am Health Drug Benefits 2011;4:107–14.

Lee D, Armaghani S, Archer KR, Bible J, Shau D, Kay H, Zhang C, McGirt MJ, Devin C. Preoperative opioid use as a predictor of adverse postoperative self-reported outcomes in patients undergoing spine surgery. J Bone Jt Surg Am 2014;96:e89.

Martin BI, Turner JA, Mirza SK, Lee MJ, Comstock BA, Deyo RA. Trends in health care expenditures: utilization, and health status among US adults with spine problems, 1997–2006. Spine (Phila Pa 1976) 2009;34:2077–84.

Parker SL, Devin CJ, McGirt MJ. 127 the association of preoperative narcotic use on length of hospital stay and 1 year return to work, pain, disability, and quality of life after elective surgery for degenerative spine disease. Neurosurgery 2015;62:206.

Armaghani SJ, Lee DS, Bible JE, Shau DN, Kay H, Zhang C, McGirt MJ, Devin CJ. Increased preoperative narcotic use and its association with postoperative complications and length of hospital stay in patients undergoing spine surgery. Clin Spine Surg 2016;29:E93–8.

Kinjo S, Sands LP, Lim E, Paul S, Leung JM. Prediction of postoperative pain using path analysis in older patients. J Anesth 2012;26:1–8.

Armaghani SJ, Lee DS, Bible JE, Archer KR, Shau DN, Kay H, Zhang C, McGirt MJ, Devin CJ. Preoperative narcotic use and its relation to depression and anxiety in patients undergoing spine surgery. Spine (Phila Pa 1976) 2013;38:2196–200.

Utrillas-Compaired A, Basilio J, Tebar-Martínez AJ, Asúnsolo-Del Barco Á. Does preoperative psychologic distress influence pain, function, and quality of life after TKA? Clin Orthop Relat Res 2014;472:2457–65.

Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJ, Ostelo RW, Guzman J, van Tulder MW. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ 2015;350:h444.

Choi BC, Pak AW. Multidisciplinarity, interdisciplinarity, and transdisciplinarity in health research, services, education and policy: 3. Discipline, inter-discipline distance, and selection of discipline. Clin Investig Med 2008;31:E41–8.

Turk DC, Okifuji A. Treatment of chronic pain patients: clinical outcomes, cost-effectiveness, and cost-benefits of multidisciplinary pain centers. Crit Rev Phys Rehabil Med 1998;10:181–208.

PROMIS Adult Profile Instruments. A brief guide to the PROMIS Profile instruments for adult respondents; 2015.

Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L. A comprehensive review of opioid-induced hyperalgesia. Pain Physician 2011;14:145–61.

Dersh J, Polatin PB, Gatchel RJ. Chronic pain and psychopathology: research findings and theoretical considerations. Psychosom Med 2002;64:773–86.

Brill S, Ginosar Y, Davidson EM. Perioperative management of chronic pain patients with opioid dependency. Curr Opin Anaesthesiol 2006;19:325–31.

Nielsen PR, Jorgensen LD, Dahl B, Pedersen T, Tonnesen H. Prehabilitation and early rehabilitation after spinal surgery: randomized clinical trial. Clin Rehabil 2010;24:137–48.

King SA, Strain JJ. Benzodiazepine use by chronic pain patients. Clin J Pain 1990;6:143–7.

Jones JD, Mogali S, Comer SD. Polydrug abuse: a review of opioid and benzodiazepine combination use. Drug Alcohol Depend 2012;125:8–18.

Piesiur-Strehlow B, Strehlow U, Poser W. Mortality of patients dependent on benzodiazepines. Acta Psychiatr Scand 1986;73:330–5.

Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood) 2008;27:759–69.

Thông tin
Thông tin xuất bản

Scandinavian Journal of Pain

Tập 13 Số 1

27-31

Thông tin tác giả