Don’t Expect to Toss the Opioids After Spinal Fusion

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Most patients I speak to who are contemplating a spinal fusion for low back pain believe that their pain will be solved and that they will be able to stop using narcotics. However, what if that wasn’t remotely true? Would they still sign up for this invasive and potentially dangerous surgical procedure? New research suggests that patients considering spinal fusion may need to come to grips with the fact that most will continue to be on narcotics after the procedure.

Why Most Patients Get a Spinal Fusion: Pain

A spinal fusion involves removing a disc in the spinal column and then using hardware, such as screws, spacers, and/or rods to force the vertebrae above and below the disc space to grow together (also called fusion) into one solid mass of bone. The purpose is to eliminate motion in the affected area of the spine. It’s a major surgery that comes with many side effects, such as adjacent segment disease, which I discuss in my video below:

Why do most patients pull the trigger on such a big, major surgery like spinal fusion? Back pain! By the time the doctor starts throwing around the word “fusion,” most patients have lived with back pain for a long time and tried lots of things to help it. A large majority of these patients are likely on long-term painkillers of some sort—maybe nonsteroidal anti-inflammatory drugs (NSAIDs) or maybe even opioids. Unfortunately, both NSAIDs and opioids are dangerous and riddled with many side effects, and studies have suggested they may not even be effective for pain in many cases.

Today I’m going to focus specifically on opioids because a new study has found that, despite the fact that most patients believe spinal fusion will eliminate or significantly reduce their pain, a very large majority are still taking opioids (narcotics) long-term after surgery and almost half are taking a higher dose than before surgery. Let’s take a look at the study.

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Very, Very Few Actually Toss the Opioids After Spinal Fusion

The purpose of the new study was to research chronic opioid use following fusion, specifically, the elimination or reduction of opioid use, when compared to preoperative use. The study consisted of 2,491 patients who’d undergone lumbar fusion. Researchers studied opioid use in these patients both before and after surgery. If patients had four or more opioid prescriptions filled within seven months of surgery, this was considered chronic, or long-term, opioid use.

Before surgery 1,045 patients had been taking opioids long-term, and 77% of these patients continued their chronic use of opioids after surgery while nearly 14% still used opioids periodically. So 91% of the preoperative opioid users were still taking opioids after surgery  in some form or fashion. In addition, 45% were taking higher doses after surgery than before.

While some of this could be attributed to the highly addictive nature of opioids, it’s disturbing to note also that 13% of fusion patients who did not take opioids before surgery were now chronic users after surgery. After surgery 1,094 were now chronic opioid users. So simply comparing raw numbers, more patients became chronic users of opioids after surgery (1,094) than before (1,045).

What does this study tell us? It’s highly unlikely you’ll be tossing the opioids after a spinal fusion, especially if you were already taking them before surgery. In fact, if you were taking opioids before surgery, there’s only a measly 9% chance you’ll be able to toss them after surgery.

This Study Shows How Poorly Spinal Fusion Works For Most Patients

Let’s say you were from Mars or Venus and you had never heard of low back fusion. However, I told you that to help your pain, I wanted to slice open your back and destroy the natural stabilizing muscles in the process. Then I wanted to remove your discs and then insert bone or a metal spacer where they used to be. Finally, I would use a power tool to insert screws into your bones that were attached to rods. In addition, the complication rate is fairly high for orthopedic surgery and there is also a good chance that over the long-run the procedure would destroy the discs above and below where I placed the hardware. However, at the end of all of this, there was only a 9% chance you could get off of medications and that more people would be on narcotics after the surgery than before the procedure. By the way, I’ll charge your insurance company tens of thousands of dollars for this crazy procedure. You would think that I was insane.

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The Best Way to Stay Off Opioids Is to Never Get on Them in the First Place

Once you’ve started taking opioids, it’s very difficult to stop, so my best advice is to never get on them in the first place. Here are a just few reasons you should say no to an opioid prescription:

The upshot? You just can’t make this stuff up. I have seen spinal fusion destroy more lives than any other single surgical procedure. While a few patients really need it and some benefit, for most, it’s really that awful. Definitely don’t sign up for this procedure to try to get off your narcotics, because according to the research, that’s very unlikely to happen.

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile

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