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.

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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.

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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.”


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