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How Opioid Medications Effect Spine Surgery Outcomes

By U.S. News & World Report

As the American legislature and medical community continue efforts to stem the tide of the growing opioid crisis in our country, researchers are working diligently to highlight what a dangerous path doctors may be putting patients on when writing prescriptions for opioid medications to address chronic back pain as a result of a spinal condition. A new study published in the Journal of Bone & Joint Surgery indicates that the duration of pre-operative opioid usage was the strongest predictor of continued use after surgery. Other studies also paint an upsetting picture of spine surgery outcomes in patients who engaged in prolonged opioid use before surgery.

Opioid usage is on a steady rise in the United States over the last few decades, particularly among people who are affected by spinal conditions that result in severe or chronic back pain. Researchers have estimated that up to half of the people who undergo spine surgery are taking opioid medications at the time of surgery, with 20 percent possibly addicted to these medications. This is an essential topic for the medical community to pay significant attention to so we can help reduce patients’ dependence on and misuse of powerful opioid narcotics that aren’t intended for long-term usage.

[See: 11 Ways to Cope With Back Pain.]

The recent Journal of Bone & Joint Surgery study indicates that people who took prescription opioid medications for six months or longer before undergoing lumbar spine surgery were more likely to continue opioid usage after surgery. Nearly all of the patients studied had some exposure to opioid medications before surgery, and they were classified into four categories: exposed, acute exposed, intermediate sustained use and chronic sustained use.

The primary risk factor for continued opioid usage after surgery was the duration of opioid usage pre-surgery. The study authors referred to a “dose-response” effect, finding that patients who took opioids for six months or longer before surgery were 65 to 74 percent less likely to stop using them after surgery than the other study subjects who had not had as much exposure to opioid medications before surgery. The good news from the study indicated that most of the patients using prescription opioids before surgery stopped using them after surgery.

[See: 4 Opioid Drugs Parents Should Have on Their Radar.]

Opioid usage before surgery is also associated with a higher risk of surgical complications and unfavorable outcomes after spine surgery. In a Journal of Neurosurgery study published in 2017, researchers evaluated the one-year follow-up, postoperative outcomes of lumbar spinal fusion patients who had used opioid medications before surgery and compared them to those who hadn’t. For the pre-surgery opioid user group, there was a higher reporting of continued back pain, greater disability and lower mental health scores (which study authors reported were also lower before surgery) than that of the non-user group 12-months after the operation had taken place. While the study did find that the health improved of all of the patients studied, whether or not they had used opioid medications before surgery, there was a significant difference in the quality of the improvement between opioid users and non-users.

The outcomes of these studies strongly suggest that patient care requires a multi-disciplinary approach between every member of a patient’s health care team working together toward the patient’s best health. We spine surgeons have a responsibility to treat our patients as whole people, not just as a spinal disorder. Because the research also indicates that other factors may contribute to continued opioid usage after surgery, it’s crucial that doctors do our part to recognize and address those factors as well — including psychosocial issues, anxiety and depression.

In some cases, this could mean psychological counseling and an intentional period of weaning from opioid medications before surgery. Of course, this isn’t to say we want to leave patients in pain. But the exploration of non-opioid methods for pain relief is gaining significant traction today and worth consideration. These alternatives can include physical therapy, massage, non-opioid medications and mindfulness meditation, to name a few. And of course, every member of a patient’s care team must commit to closely monitoring any opioid medications being used after surgery.

[See: 10 Ways Poor Posture Can Harm Your Health.]

As a spine surgeon, I’ve seen and heard the railing against spine surgery as a “treatment for back pain.” However, as a medical community and society, what if we began to view prescription opioid medications as a dangerous treatment for back pain? While I’ve written extensively on the concept that spine surgery should neither be the first line of defense in addressing a spinal condition (unless a traumatic, catastrophic injury has been sustained) nor is it a “magic bullet” cure that will fix everyone’s spinal concerns, it can save the right candidates’ quality of life. A lifetime of opioid addiction is certainly not a better alternative. We doctors owe our patients a far better prognosis than that.

More from U.S. News

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10 Ways to Prepare for Surgery

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How Opioid Medications Effect Spine Surgery Outcomes originally appeared on usnews.com

Don’t Settle for Student Loans to Pay for Online Education

By WTOP Staff
Online college programs are becoming a more popular choice for prospective students, with one study finding that more than 6 million students enrolled in at least one online course in fall 2015. The popularity of these courses can be attributed in part to their flexibility with working adults' schedules, students' ability to progress more quickly through online programs and, oftentimes, cheaper tuition. [See 10 low-cost online bachelor's programs for out-of-state students.]Online degrees can be beneficial to many college students, but some studies have shown online learners complete their programs at lower rates than students at traditional brick-and-mortar campuses. Individuals with student loans but no degree comprise two-thirds of defaulted borrowers. Though these numbers are not encouraging, just like for traditional programs, there are ways to reduce how much you'll need to borrow for an online program to ensure you won't become one of these statistics. Don't just settle on borrowing student loans to cover the whole cost of your program and living expenses. Instead, start thinking about how to cut costs and cover your balance in different ways, such as the following. -- Grants and scholarships: Even though you are taking an online course, you can still apply and receive grants and scholarships. But your first step should be to complete the Free Application for Federal Student Aid, commonly referred to as the FAFSA, which will allow you to receive a Pell Grant if your expected family contribution is low enough. The EFC criteria and award amounts are adjusted annually, but the 2017-2018 academic year awards range from $606 to $5,920, which could significantly lower the amount you borrow annually. Your next step is to apply for scholarships. You can start by checking online scholarship search engines, such as the Salt Scholarship Search, College Board's BigFuture and Peterson's. But don't forget to take advantage of local organizations and your school's financial aid office. Both may offer scholarships that you can't find with a national scholarship search. [Review these 10 sites to kick off your scholarship search.]For instance, organizations like the Elks Club, Knights of Columbus or the Rotary Club typically offer scholarships annually to local students. Just because you're going to school online doesn't mean you're ineligible. Visit your local library for scholarship listings, and ask around town. You might be surprised how many local organizations offer scholarships. While these scholarships typically aren't large, every little bit counts. Each dollar you receive in a scholarship is a dollar you don't have to borrow and pay interest on. -- Work-study: Another option for online students may be work-study awards. Not all students enrolled in online programs are eligible, but students at some schools -- including, for example, SUNY Empire State College and Liberty University -- are. Work-study awards are not given upfront like scholarships and grants. In most cases, they are an offer to earn up to the awarded amount if you secure an eligible work-study job. While there is a misconception that all work-study jobs must be on campus, students can work for off-campus, nonprofit or public employers as long as the work is in the public's interest. You may be able to work for a for-profit employer if the job is relevant to your course of study. No matter who the outside employer is, it will need to have an established agreement with your college for you to receive work-study funds. Remember, to be eligible for federal financial aid, you must be enrolled and pursuing a degree or certificate. If you're not working toward a credential, Pell Grants and work-study won't be option, but you may still be able to take advantage of private scholarships -- just be sure to read the eligibility criteria carefully. [Explore what to know about financial aid in online programs.]-- Pay as you go: One of the great benefits to enrolling online is the flexible schedule, which can allow you to complete your college coursework around your responsibilities. But prospective students often overlook using their part- or full-time job earnings as an option for paying for college. Almost 80 percent of college students in 2015 worked at least part time while attending classes, according to the National Center for Education Statistics. By budgeting and thinking strategically about your college costs, you can likely reduce your dependence on student loans by paying a portion out of pocket. Many -- but not all -- online programs are less expensive than traditional programs and often have shorter payment periods. Six, eight or 10 weeks are common course durations. Because of the frequency of payments in an online setting, you may be well-placed to pay as you go and possibly avoid borrowing altogether. Attending college online and avoiding student loans may be challenging, but if you are willing to put in the effort, you can limit the amount you need to borrow. More from U.S. News Q&A: Understanding Student Loan Discharge Eligibility Student Loan Refinancing Isn't Right for All Borrowers
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