PMID- 28962907 OWN - NLM STAT- MEDLINE DCOM- 20190111 LR - 20190111 IS - 1878-1632 (Electronic) IS - 1529-9430 (Linking) VI - 18 IP - 5 DP - 2018 May TI - Effect of pre-injection opioid use on post-injection patient-reported outcomes following epidural steroid injections for radicular pain. PG - 788-796 LID - S1529-9430(17)31002-1 [pii] LID - 10.1016/j.spinee.2017.09.009 [doi] AB - BACKGROUND CONTEXT: Chronic opioid therapy is associated with worse patient-reported outcomes (PROs) following spine surgery. However, little literature exists on the relationship between opioid use and PROs following epidural steroid injections for radicular pain. PURPOSE: We evaluated the association between pre-injection opioid use and PROs following spine epidural steroid injection. STUDY DESIGN: This study is a retrospective analysis of a prospective longitudinal registry database. PATIENT SAMPLE: A total of 392 patients within our database who were undergoing epidural steroid injections (ESIs) at our institution for degenerative structural spine diagnoses and met our inclusion criteria were included in this study. OUTCOME MEASURES: Patient-reported outcomes for disability (Oswestry Disability Index/Neck Disability Index [ODI/NDI)]), quality of life (EuroQol-5D [EQ-5D]), and pain (Numerical Rating Scale scores for back pain, neck pain, leg pain, and arm pain [NRS-BP/NP/LP/AP]) were assessed at baseline and at 3 and 12 months post-injection. METHODS: Multivariable proportional odds logistic regression models were created to examine the relationship between pre-injection opioid use and post-injection PROs. A logistic regression with Bayesian Markov chain Monte Carlo parameter estimation was used to investigate a possible cutoff value of pre-injection opioid use above which the effectiveness of ESI (as measured by minimum clinically important difference [MCID] for ODI/NDI) decreases. RESULTS: A total of 276 patients with complete 12-month follow-up following ESI were analyzed. The mean pre-injection daily morphine equivalent amount (MEA) was 14.7 mg (95% confidence interval [CI] 12.4 mg-19.1 mg) for the cohort. Pre-injection opioid use was associated with slightly higher odds of worse disability (odds ratio [OR] 1.03, p=.03) and leg/arm pain (OR 1.01, p=.04) scores at 3 months post-injection only. No significant association between pre-injection opioid use and MCID for ODI/NDI was found, although a cutoff of 55.5 mg/day might serve as a significant threshold. CONCLUSION: Increased pre-injection opioid use does not impact long-term outcomes after ESIs for degenerative spine diseases. A pre-injection MEA around 50 mg/day may represent a threshold above which the 3-month effectiveness of ESI for back- and neck-related disability decreases. Epidural steroid injection is an effective treatment modality for pain in patients using opioids, and can be part of a multimodal strategy for opioid independence. CI - Copyright (c) 2017. Published by Elsevier Inc. FAU - Wei, Johnny J AU - Wei JJ AD - Department of Orthopedic Surgery, Vanderbilt University, School of Medicine Medical Center East, South Tower, Suite 4200, Nashville, TN 37232-8774, USA. FAU - Chotai, Silky AU - Chotai S AD - Department of Orthopedic Surgery, Vanderbilt University, School of Medicine Medical Center East, South Tower, Suite 4200, Nashville, TN 37232-8774, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, 1161 21st Ave. So. T4224 Medical Center North, Nashville, TN 37232-2380, USA. FAU - Sivaganesan, Ahilan AU - Sivaganesan A AD - Department of Neurological Surgery, Vanderbilt University Medical Center, 1161 21st Ave. So. T4224 Medical Center North, Nashville, TN 37232-2380, USA. FAU - Archer, Kristin R AU - Archer KR AD - Department of Orthopedic Surgery, Vanderbilt University, School of Medicine Medical Center East, South Tower, Suite 4200, Nashville, TN 37232-8774, USA; Department of Physical Medicine and Rehabilitation, Vanderbilt Stallworth Rehabilitation Hospital 2201 Children's Way, Suite 1318, Nashville, TN 37212, USA. FAU - Schneider, Byron J AU - Schneider BJ AD - Department of Physical Medicine and Rehabilitation, Vanderbilt Stallworth Rehabilitation Hospital 2201 Children's Way, Suite 1318, Nashville, TN 37212, USA. FAU - Yang, Aaron J AU - Yang AJ AD - Department of Physical Medicine and Rehabilitation, Vanderbilt Stallworth Rehabilitation Hospital 2201 Children's Way, Suite 1318, Nashville, TN 37212, USA. FAU - Devin, Clinton J AU - Devin CJ AD - Department of Orthopedic Surgery, Vanderbilt University, School of Medicine Medical Center East, South Tower, Suite 4200, Nashville, TN 37232-8774, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, 1161 21st Ave. So. T4224 Medical Center North, Nashville, TN 37232-2380, USA. Electronic address: clintondevin@gmail.com. LA - eng PT - Journal Article DEP - 20170928 PL - United States TA - Spine J JT - The spine journal : official journal of the North American Spine Society JID - 101130732 RN - 0 (Analgesics, Opioid) RN - 0 (Steroids) SB - IM MH - Adult MH - Aged MH - Analgesics, Opioid/administration & dosage/*adverse effects/therapeutic use MH - Back Pain/*drug therapy MH - Female MH - Humans MH - Injections, Epidural MH - Male MH - Middle Aged MH - *Patient Reported Outcome Measures MH - Steroids/administration & dosage/*therapeutic use OTO - NOTNLM OT - Cervical OT - Epidural steroid injection OT - Lumbar OT - Opioids OT - Patient-reported outcomes OT - Spine EDAT- 2017/10/01 06:00 MHDA- 2019/01/12 06:00 CRDT- 2017/10/01 06:00 PHST- 2017/06/05 00:00 [received] PHST- 2017/08/16 00:00 [revised] PHST- 2017/09/20 00:00 [accepted] PHST- 2017/10/01 06:00 [pubmed] PHST- 2019/01/12 06:00 [medline] PHST- 2017/10/01 06:00 [entrez] AID - S1529-9430(17)31002-1 [pii] AID - 10.1016/j.spinee.2017.09.009 [doi] PST - ppublish SO - Spine J. 2018 May;18(5):788-796. doi: 10.1016/j.spinee.2017.09.009. Epub 2017 Sep 28.