Higher Opioid Doses Predict Poorer Functional Outcome in Patients with Chronic Disabling Occupational Musculoskeletal Disorders

• Published in: Journal of bone and joint surgery. American volume 2009-04, Vol.91 (4), p.919-927
• Main Authors: Kidner, Cindy L, Mayer, Tom G, Gatchel, Robert J
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Chronic Disease; Disability Evaluation; Diseases of the osteoarticular system; Female; Humans; Male; Medical sciences; Miscellaneous. Osteoarticular involvement in other diseases; Musculoskeletal System - injuries; Narcotics - therapeutic use; Occupational Diseases - rehabilitation; Orthopedic surgery; Pain - drug therapy; Pain - etiology; Pain Measurement; Recovery of Function; Scientific; Socioeconomic Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.H.00286

BackgroundOpioids are frequently used for the postoperative treatment of chronic disabling occupational musculoskeletal disorders. In many such cases, long-term opioid use persists because of patient requests for ongoing pain relief. Little is known about the relationship between chronic opioid use and functional recovery in these patients.MethodsA total of 1226 patients with a chronic disabling occupational musculoskeletal disorder were consecutively admitted into an interdisciplinary functional restoration program. They were divided into two groups630 patients who reported no opioid use at the time of admission (No group) and 596 patients who reported some opioid use at the time of admission (Yes group). The 516 patients for whom daily opioid doses could be determined were further divided into four subgroupsLow (120 mg, n = 59). During the initial weeks of treatment, patients consented to be weaned from all opioid medications. In addition, the patients were assessed before and after rehabilitation with regard to self-reported measures of pain, function, and depression and were analyzed for change. One year after the termination of treatment, socioeconomic outcomes were assessed to measure work and financial status, healthcare utilization, and recurrent injury-associated pain.ResultsA higher post-injury opioid dose was associated with a greater risk of program noncompletion, which was anticipated because of the requirement that patients taper opioids. High opioid use was significantly related to important socioeconomic outcomes, such as lower rates of return to work and work retention as well as higher healthcare utilization (p ≤ 0.05 for all). Moreover, at one year after treatment, the group reporting the highest opioid use was 11.6 times as likely to be receiving Social Security Disability Income/Supplemental Security Income as compared with the group reporting no opioid use at the time of admission into the program.ConclusionsChronic opioid use beginning after a work-related injury is a predictor of less successful outcomes for patients whose final treatment intervention is an interdisciplinary functional restoration program. Higher dose levels are associated with progressively greater indemnity and medical costs for ongoing disability. Physicians involved in the treatment of chronic disabling occupational musculoskeletal disorders should be aware of problems