Department of Physical Medicine and Rehabilitation Satakunta Central Hospital (Satasairaala), Finland.
Pain Physician. 2022 Aug;25(5):E733-E738.
Preoperative exposure to opioids 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 aimed to determine the effect of pretreatment opioid use on outcomes after interventional pain management procedures on patients with chronic back pain.
A retrospective study.
Department of Physical Medicine and Rehabilitation at Satakunta Central Hospital (Satasairaala), Finland.
A high-volume, single-center, quality register analysis was performed on patients who underwent interventional pain management for suspected facet-mediated chronic back pain as a part of a multidisciplinary pain management program. Chronic opioid use was defined as having a concurrent opioid prescription for 90 days.
A total of 797 patients underwent an intervention during the study period from August 1, 2019 through December 31, 2020. Pretreatment opioid use was present in 262 patients (33%). Patients with chronic back pain using opioids reported significantly more pain and discomfort before treatment as well as lowered working ability. Facet joint medial branch blocks resulted in significant improvement for both groups directly after the treatment as well as at 2-hours follow-up. However, the nonopioid group reported significantly more improvement at 2-days follow-up as well as at one month follow-up compared to opioid users. Opioid users reported nearly the same pain level at one-month follow-up as they did before treatment.
As a single-center analysis, these data may not be generalizable to other institutions. A retrospective study may include inevitable bias. The disease processes themselves may possibly predispose patients to different degrees of opoid use. Although we have identified preoperative opioid use as a risk factor for treatment failure, we were unable to determine the size of the association based on our statistical analysis and sample size. Pain intensity evaluation using the visual analog scale is inevitably subjective.
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 one-month follow-up. In our study, opioid users reported the same positive effects of facet joint nerve blocks immediately after the treatment and 2 hours after the treatment, but a significantly smaller effect at one-month follow-up. This could indicate that opioid use may diminish the effects of pain treatments by affecting relearning, behavioral changes, and central pain modulation. These findings may help providers understand the effect of pretreatment opioid use on patient care, and its implications on hospital and societal costs.
最近的研究表明，术前接触阿片类药物与择期大手术后的不良结局有关，但对于预处理阿片类药物的使用如何影响介入性腰痛管理的结果知之甚少。
我们旨在确定术前使用阿片类药物对慢性腰痛患者接受介入性疼痛管理治疗后的结果的影响。
回顾性研究。
芬兰萨塔昆塔中央医院（Satasairaala）物理医学与康复科。
对接受介入性疼痛管理治疗疑似小关节介导的慢性腰痛的患者进行了一项高容量、单中心、质量登记分析，这些患者是多学科疼痛管理计划的一部分。慢性阿片类药物使用定义为同时开具 90 天的阿片类药物处方。
在 2019 年 8 月 1 日至 2020 年 12 月 31 日期间，共有 797 名患者接受了治疗。262 名（33%）患者在治疗前使用了阿片类药物。使用阿片类药物的慢性腰痛患者在治疗前报告的疼痛和不适明显更多，工作能力也明显降低。关节突关节内侧支阻滞治疗后即刻以及 2 小时随访时两组均有显著改善。然而，与阿片类药物使用者相比，非阿片类药物组在 2 天随访和 1 个月随访时的改善更为显著。阿片类药物使用者在 1 个月随访时的疼痛水平与治疗前几乎相同。
由于是单中心分析，这些数据可能不适用于其他机构。回顾性研究可能会存在不可避免的偏差。疾病本身可能使患者对阿片类药物的使用程度不同。尽管我们已经确定术前使用阿片类药物是治疗失败的一个风险因素，但我们无法根据我们的统计分析和样本量确定关联的大小。使用视觉模拟量表评估疼痛强度不可避免地具有主观性。
术前使用阿片类药物与更大的疼痛不适、功能障碍和降低的功能能力相关，以及在 1 个月随访时介入性腰痛治疗的长期效果更差。在我们的研究中，阿片类药物使用者在治疗后即刻和治疗后 2 小时报告了相同的关节突关节神经阻滞的积极效果，但在 1 个月随访时的效果显著较小。这可能表明阿片类药物的使用可能通过影响再学习、行为改变和中枢疼痛调节来降低疼痛治疗的效果。这些发现可能有助于提供者了解术前使用阿片类药物对患者护理的影响，以及对医院和社会成本的影响。
