Opioid dependence linked to worse outcomes in back injury patients

Problems may stem from treatment. Experts say a new study offers another warning to use these drugs judiciously.

By Victoria Stagg Elliott, AMNews staff. Oct. 23/30, 2006.

Patients with chronic back injuries who become dependent on opioids during the course of their treatments use far more health care services and are less likely to return to work than are those who do not abuse these drugs, according to a study presented at the North American Spine Society's annual meeting last month in Seattle.

"Don't be afraid to use opioids early in the course of the disease or for severe exacerbations," said Tom Mayer, MD, lead author and medical director of the PRIDE, Productive Rehabilitation Institute of Dallas for Ergonomics. "But with long-duration use, there are significant risks."

Dr. Mayer and his team followed 1,200 patients who completed the institute's rehabilitation program. They had been treated for an average of a year and a half before starting the program, and 1.3% were opioid-dependent before their injuries. This number increased to 14.3% during initial treatment but prior to entering the program, which requires participants to taper from the medications.

Despite the fact that the patients all finished their rehabilitation off the medications, earlier dependence clearly exacted a price. A year after finishing rehab, those who were dependent were 2.8 times less likely to have returned to work. They were also 2.1 times more likely to have sought additional health care services and 1.8 times more likely to have had additional surgeries.

"Opioid dependence disorder in these patients is almost an entirely iatrogenic issue, and patients may well have a poorer outcome," said Dr. Mayer.