Does opioid pain medication use affect the outcome of patients with lumbar disc herniation?

Abstract

Study design: Subgroup analysis of prospective, randomized cohort.

Objective: To review the results of patients who received opioid pain medications during treatment compared with that of patients who did not receive opioid medications.

Summary of background data: The Spine Patient Outcomes Research Trial (SPORT) is a prospective, multicenter study of surgical treatment versus nonoperative treatment for lumbar intervertebral disc herniation.

Methods: The study population includes patients enrolled in SPORT for treatment of intervertebral disc herniation in combined randomized and observational cohorts. Patients who received opioid medications at baseline (opioid) were compared with those who did not (nonopioid).

Results: There were 520 patients in the nonopioid group and 542 patients in the opioid group. Among the opioid medication group, there were significantly (P < 0.001) worse baseline scores in primary and secondary outcome measures. There was an increased percentage of patients in the opioid medication group with the perception of worsening symptoms and neurological deficit (P < 0.001). A higher percentage of the opioid group patients received surgery (P < 0.001).At 4 years of follow-up, there were no significant differences in primary or secondary outcome measures or treatment effect of surgery between opioid and nonopioid medication group patients. Opioid medications were associated with increased crossover to surgical treatment (P = 0.005) and decreased surgical avoidance (P = 0.01). The incidence of opioid use at 4 years was 16% among patients who were using opioids at baseline and 5% among patients who were not using opioids at baseline.

Conclusion: Patients who were treated with opioids had significantly worse baseline pain and quality of life. At final follow-up, there was no long-term difference in outcome associated with opioid pain medication use. Opioid medications were not associated with surgical avoidance. The majority of patients who use opioids during the study did not continue usage at 4 years.

Level of evidence: 2.

Figure 1

Diagram displaying the enrollment and study design.

Figure 2

Primary Outcomes over Time for Non-Narcotics and Had-Narcotics Use at Baseline. Surgery p-value compares Non-Narcotics to Had-Narcotics among surgery. Non-operative p-value compares Non-Narcotics to Had-Narcotics among non-operative. Interaction p-value compares treatment effect (surgery vs. non-operative) between Non-Narcotics and Had-Narcotics.* P-values are time weighted average 4 years (Area Under Curve p-values).

Figure 3

Percentage of patients with long term Narcotic use at one, two, three, and four years. Opioid patient group were patients who were treated with opioid pain medications at the time of enrollment in the study. No-Opioid patients were not treated with opioid pain medications at time of enrollment in the study.