Patients With Lower Back Injury May Be Off Work Longer if Opioids Started Soon After InjuryLower back injuries are common in Western society and many workers who develop lower back pain end up on long-term disability. Researchers have looked at the risk factors that may lead to long-term disability from lower back injuries. One small study found that patients who were given opioids for more than seven days after the initial injury, had a higher risk of being off work for longer periods.
Initial treatment recommendations for lower back injuries in the United States and Europe includes the use of acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), with use of opioids only if the pain is severe and only for several days, not for a long term.
Researchers have found that patients who had higher pain and worse functioning also had higher opioid use, so the authors of this study wanted to evaluate if opioid prescriptions within six weeks of injury are associated with one-year disability.
The patients in the study, 1,843, were who had received or who were receiving work disability compensation. There ages ranged from 18 to 77 years, with a mean age of 39.4 years. The researchers assessed the patients with a baseline telephone interview that reviewed questions about their socioeconomic status and tobacco and alcohol use. Patients were asked to rate their pain and whether the pain radiated into a leg. Their ability to function was rated by the Roland-Morris Disability Questionnaire (RDQ) and the injury severity was rated with an instrument developed in a previous study.
Also assessed in the study was the patients' view of where they would be in six months, whether they would be working. Workers gave answers from not certain at all about returning to work to extremely certain.
The researchers assessed opioid prescriptions through data including billing records. By learning which workers received an opioid prescription at or within six weeks of their injury, they were able to calculate how much of the opioids the patients likely took.
Study findings revealed that of the 1,843 patients, 245 (14 percent) were off work at 1 year after the injury; of the 1,843 patients, 630 received opioid prescriptions within six weeks of the injury and slightly more than half of these patients received the prescriptions during their first doctor visit. The mean number of days for prescriptions was 12.1 days, 5.1 days over the seven-day treatment recommendation.
The authors write that the findings of opioids given for more than seven days within the first six weeks following the injury was associated with a higher risk of the worker being off work for longer periods. The relationship, however, is still unknown.
Weaknesses in the study include the self-assessment of the workers over the phone, during which the use of the opioids may have altered the pain and function and, thus, their responses.
In conclusion, the authors say their "findings suggest consideration of some caution in prescribing opioids early after a work-related back injury." They continue to say that if opioids are to be used, their use should be limited to that of less than a week.
Gary M. Franklin, MD, et al. Early Opioid Prescription and Subsequent Disability Among Workers With Back Injuries. In Spine. January 15, 2008. Vol. 33. No. 2. Pp. 199-204.
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