Impact of Opioid Use on Results of Interventional Back-Pain Management on Patients with Chronic Back Pain

Abstract

Hannu Heikkila, Aet Ristmagi

Objectives Preoperative exposure to opiates has recently shown to be associated with poor outcomes after elective major surgery, but little is known as to how pretreatment opioid use affects results of interventional back-pain management. We investigated the impact of preoperative opioid use on outcomes after interventional pain management procedures on patients with chronic back pain.

Methods A high-volume, single-center quality register analysis was performed on patients who underwent interventional pain management for chronic back pain as a part of multidisciplinary pain management program. Chronic opioid use was defined as having an opioid prescription concurrent with 90 days.

Results: A total of 797 patients underwent intervention during the study period 2019-2020. Pretreatment opioid use was present in 262 patients (33%). Patients with chronic back-pain using opiates reported significantly more pain and discomfort before treatment as well as lowered working ability. Facet-joint medial branch blocks resulted for significant improvement for both groups directly after the treatment as well as at 2-hours follow-up. However, non-opiate group reported significantly more improvement at 2-days follow up as well as at one- month follow-up compared to opiate users. Opiate users reported nearly the same pain level at one-month follow-up as before treatment.

Conclusions: Pretreatment opioid use is associated with greater pain discomfort, impairment and reduced functional ability, as well as poorer long-term effect of interventional back pain treatment at 1-month follow-up. In our study opiate users reported same positive effects of facet-joint nerve blocks immediately after the treatment and 2 hours after the treatment but significantly smaller effect at one-month follow-up. This could indicate that opiate use may diminish effects of pain treatments by affecting relearning, behavioral changes and central pain modulation. These findings may help to understand the impact of pretreatment opioid use on patient care, and its implications on hospital and societal cost.

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