Smoking and non-surgical treatment of back pain are predictors of long-term opioid use, according to a new study in The Journal of Pain.
In what’s believed to be the first longitudinal study to assess predictors of long-term use of these potent drugs, researchers collected data from the Spine Patient Outcomes Research Trial (SPORT) on patients with lower back pain due to spinal stenosis or a herniated disc.
According to the study’s findings, 42% of the patients reported opioid use at baseline. At 12 months, 25% of these patients reported continued use. At 24 months, 21% of the patients reported continued opioid use.
From this data, researchers were able to determine that smoking and non-surgical treatment of lower back pain independently predicted continued opioid use in the long-term.
According to the study, knowing that smoking and non-surgical treatment of back pain in the lumbar spine increase the risk of long-term opioid use may alter how doctors go about treating symptoms, perhaps by not prescribing opioids at all in such instances.
Also known as narcotics, opioids are powerful analgesic drugs that can provide effective short-term relief of severe lower back pain. However, given the potentially addictive nature and overdose risks of opioids like oxycodone, hydromorphone and hydrocodone, some doctors are leery of prescribing them for chronic conditions.
Patients with lower back pain from a lumbar herniated disc (when the inner core of a disc extrudes through its outer core and comes in contact with and irritates a nearby nerve root) may consider other non-surgical treatments besides opioids, including non-steroidal anti-inflammatory drugs, oral steroids, epidural injections, physical therapy, and/or osteopathic or chiropractic manipulation.
The same goes for patients with lumbar spinal stenosis (when the spinal nerves in the lower back are choked), which can be treated non-surgically with NSAIDs, epidural injections, activity modification and exercise.
If lower back pain symptoms continue to persist and cause severe limitations in physical ability after months of different types of non-surgical care, patients may consider back surgery.