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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald

4 Issues per year


CiteScore 2017: 0.84

SCImago Journal Rank (SJR) 2017: 0.401
Source Normalized Impact per Paper (SNIP) 2017: 0.452

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1877-8879
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Volume 13, Issue 1

A preoperative interdisciplinary biopsychosocial opioid reduction program in patients on chronic opioid analgesia prior to spine surgery: A preliminary report and case series

Sameer Hassamal
  • Corresponding author
  • Department of Addiction Psychiatry, University of California Los Angeles/Kern Medical, Bakersfield, CA, United States
  • Department of Psychiatry and Neurology, University of California Riverside, Riverside, CA, United States
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Margaret Haglund
  • Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Karl Wittnebel / Itai Danovitch
  • Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2016-10-01 | DOI: https://doi.org/10.1016/j.sjpain.2016.06.007

Abstract

Background

Spine surgery candidates are commonly treated with long-term opioid analgesia. However, chronic opioid analgesia is associated with poor pain control, psychological distress, decreased functional status and operative complications. Therefore, our medical centre piloted an outpatient biopsychosocial interdisciplinary opioid reduction program for spine surgery candidates on chronic opioid analgesia.

Methods

Our case series reviews the outcomes of the first 5 interdisciplinary program completers. Data was collected on admission to the program, preoperatively at completion of the program, and 1 month postoperatively. We recorded changes in pain interference scores, physical functioning, and symptoms of depression and anxiety as captured by the Patient-Reported Outcome Measurement Information System (PROMIS-29) Profile.

Results

The mean duration of the preoperative opioid reduction program was 6–7 weeks. The mean morphine equivalent daily dose (SD) decreased from 238.2 (226.9) mg on admission to 157.1 (161.0) mg preoperatively and 139.1 (84.0) mg one month postoperatively. Similarly, the mean pain interference score (SD) decreased from 72.4 (5.1) on admission to 66.5 (6.9) preoperatively and 67.7 (5.4) one month postoperatively. The preoperative opioid dose and pain interference scores decreased in all 5 patients, but one month postoperatively increased in one patient related to a surgical complication. Pre- and postoperative depression, anxiety and fatigue improved in all patients. Satisfaction with participation in social roles, sleep disturbances, and physical functioning improved in most patients.

Conclusions

Pre- and post-operative pain improved despite the opioid dose being tapered. These preliminary data suggest that a short-term outpatient preoperative interdisciplinary biopsychosocial opioid reduction program is safe, feasible, and improves patient-centred outcomes.

Implications

Our preliminary data support the rationale for expansion of the opioid reduction program; opioid use and pain should be evaluated in all surgical candidates. These findings need to be replicated in larger studies.

Keywords: Chronic pain/rehabilitation; Interdisciplinary communication; Pain measurement; Patient outcome assessment; Narcotics/adverse effects; Spine/surgery

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About the article

Department of Addiction Psychiatry, UCLA-Kern, 1700 Mount Vernon Avenue, Bakersfield, CA 93306, United States. Tel.: +1 626 399 1005.


Received: 2016-05-09

Revised: 2016-06-15

Accepted: 2016-06-16

Published Online: 2016-10-01

Published in Print: 2016-10-01


Ethical issues: The Cedars-Sinai Medical Center Institutional Review Board (IRB) approved this retrospective chart review case series.

Conflicts of interest: The authors report no conflicts of interest concerning the materials or methods used in this study or the findings specified in this paper. There are no financial interests to disclose.


Citation Information: Scandinavian Journal of Pain, Volume 13, Issue 1, Pages 27–31, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1016/j.sjpain.2016.06.007.

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