Epidural Steroid Injection Outcomes and Prior Opioid Use

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The researchers evaluated the association between pre-injection opioid use and post-injection patient-reported outcomes.
The researchers evaluated the association between pre-injection opioid use and post-injection patient-reported outcomes.

Opioid use prior to epidural steroid injections for degenerative spine diseases may not have an impact on the long-term effectiveness of the injections, according to the results of a recent study published in The Spine Journal.

In a retrospective analysis of a longitudinal registry database, 392 participants undergoing epidural steroid injections were assessed. The researchers evaluated the association between pre-injection opioid use and post-injection patient-reported outcomes for disability, quality of life, and pain at 3 and 12 months.

In the 276 patients who completed 12-month follow-up, the mean pre-injection daily morphine equivalent amount was 14.7 mg (95% CI, 12.4-19.1 mg). At 3-months post-injection, pre-injection opioid use was correlated with increased risk for disability (odds ratio [OR], 1.03; P =.03) and leg or arm pain (OR, 1.01; P =.04). However, by 12 months prior opioid use did not have an impact on pain scores.

Pre-injection use of more than 55.5 mg/day morphine equivalent amount was estimated to be a cutpoint, above which the efficacy of epidural steroid injections may decrease.

The researchers concluded that "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."

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Reference

Wei JJ, Chotai S, Sivaganesan A, et al. Effect of pre-injection opioid use on post-injection patient-reported outcomes following epidural steroid injections for radicular pain [published online September 26, 2017]. Spine J. doi: 10.1016/j.spinee.2017.09.009

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