Our Summary

This study measured daily opioid use and pain levels in 85 patients who had a certain type of back surgery (one-level lumbar decompression or microdiscectomy) at two institutions between September 2017 and 2018. The scientists wanted to find out how much opioid medication was necessary to help patients manage post-surgery pain, which might help prevent over-prescription of these drugs and reduce the risk of misuse or addiction.

Patients with a history of opioid dependence were not included in the study. The researchers used automated text messages to collect data on daily opioid use and pain levels for six weeks or until the patients stopped taking the medication. They also monitored if patients needed more medication during the study period and asked about leftover pills and how they were disposed of.

The results showed that the total opioid use per patient ranged from 0 to 118 pills, with an average use of 32 pills. Three-quarters of patients took 57 pills or fewer. Pain levels generally decreased over the first two weeks after surgery. By the seventh day after surgery, half of the patients had stopped taking opioids. Only about 22% of patients used up their first prescription, and just under 10% needed a refill.

These findings can be used to create evidence-based guidelines for prescribing opioids after back surgery, set standards, and identify patients who might be at the higher end of opioid use.

FAQs

  1. What was the purpose of the study on opioid use in patients who had undergone microdiscectomy surgery?
  2. How was data on daily opioid use and pain levels collected from these patients?
  3. What were the main findings of the study regarding opioid use and pain management after microdiscectomy surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about microdiscectomy is to closely follow the prescribed opioid medication schedule and only take the medication as needed for pain. It is important to communicate any changes in pain levels to your healthcare provider so they can adjust your medication as necessary. Additionally, it is important to properly dispose of any leftover medication to prevent misuse or accidental ingestion by others.

Suitable For

Patients who are typically recommended microdiscectomy are those who have a herniated disc in the lumbar spine causing symptoms such as leg pain, numbness, weakness, or difficulty walking. Microdiscectomy is often recommended for patients who have not found relief from conservative treatments such as physical therapy, medication, or injections. It is also important for patients to have realistic expectations about the surgery and be willing to participate in rehabilitation and follow-up care. Patients with a history of opioid dependence may not be recommended for this surgery due to the potential for misuse or addiction.

Timeline

Before microdiscectomy:

  1. Patient experiences symptoms of a herniated disc, such as back pain, leg pain, and numbness.
  2. Patient consults with a healthcare provider and undergoes diagnostic tests to confirm the herniated disc.
  3. Patient and healthcare provider discuss treatment options, including conservative measures like physical therapy and medications.
  4. After conservative measures fail to provide relief, patient and healthcare provider decide on surgical intervention, such as microdiscectomy.

After microdiscectomy:

  1. Patient undergoes microdiscectomy surgery to remove the herniated portion of the disc.
  2. Patient is monitored in the hospital for a brief period before being discharged home.
  3. Patient is prescribed opioid medication for post-surgery pain management.
  4. Patient experiences decreasing pain levels in the first two weeks after surgery.
  5. By the seventh day post-surgery, half of patients have stopped taking opioids.
  6. Only a small percentage of patients require a refill of their opioid prescription.
  7. Patient’s pain levels continue to improve as they recover from surgery.
  8. Patient follows up with healthcare provider for post-operative care and rehabilitation.

What to Ask Your Doctor

Some questions a patient should ask their doctor about microdiscectomy include:

  1. How much opioid medication will I be prescribed after the surgery?
  2. What are the potential side effects of the opioid medication prescribed?
  3. How long should I expect to be on opioids for pain management after the surgery?
  4. Are there alternative pain management options to opioids that I can consider?
  5. What is the plan for tapering off the opioid medication after the initial post-surgery period?
  6. How will my pain levels be monitored after the surgery?
  7. Are there any specific factors that may indicate I will need more opioid medication than the average patient?
  8. What should I do with any leftover opioid medication once I no longer need it for pain management?
  9. Are there any risks associated with taking opioids after this type of surgery?
  10. How will my recovery and pain management plan be tailored to my individual needs and circumstances?

Reference

Authors: Lovecchio F, Premkumar A, Stepan JG, Mejia D, Stein D, Patel DV, Lafage V, Derman P, Khechen B, Iyer S, Lebl D, Qureshi S, Huang R, Singh K, Albert TJ. Journal: Spine (Phila Pa 1976). 2019 Nov 15;44(22):1599-1605. doi: 10.1097/BRS.0000000000003129. PMID: 31689255