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 1 , 4 , Margaret Haglund 2 , Karl Wittnebel 3 , and Itai Danovitch 2
  • 1 Department of Addiction Psychiatry, University of California Los Angeles/Kern Medical, Bakersfield, CA, United States
  • 2 Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
  • 3 Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
  • 4 Department of Psychiatry and Neurology, University of California Riverside, Riverside, CA, United States
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
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, Margaret Haglund
  • Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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, Karl Wittnebel
  • Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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and Itai Danovitch
  • Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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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.

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