Opioids/Medications

Even if you need surgery, try to get off opioids

By on September 22nd, 2016

Doesn’t matter which medical center or what diagnosis is studied: approximately 20% of patients undergoing surgery do not respond even with a technically well done surgery. Preoperative opioid usage is one of the main modifiable risk factors that contribute to poor outcome (others include uncontrolled diabetes, obesity, psychiatric disorders).

In a recent study of preoperative opioid usage, the authors showed that patients who suffer from depression and anxiety have a much higher need for narcotics. In addition, patients using more narcotics were more likely to be depressed and anxious.

Additionally, patients with essentially identical conditions with identical, technically well-done surgeries, had much worse outcomes at 12 months after surgery if they were using opioids pre-operatively!

Regarding the eventual goal of being opioid independent, if patients were on preoperative opioids, they were less likely to be able to eventually wean off narcotics. Only 41% of patients who used pre-op opioids were able to eventually free themselves of opioid use, where 74% of pre-op non-users were able to achieve opioid independence. 65% of depressed patients continued on narcotics compared to 38% who weren’t depressed. Also, 30% of readmissions are due to inadequate pain control, which was much more common in pre-operative opioid users.

Bottom line is that patients undergoing surgery will likely have a better surgical outcome and are much more likely to be able to eventually completely wean off narcotics if they don’t take opioids preoperatively.

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Kamshad Raiszadeh, M.D.

Dr. Raiszadeh's completed medical school at UC San Francisco, orthopedic surgery residency at UC Davis and his Pediatric and Adult Spine Fellowship at the Hospital for Joint Diseases/NYU in New York City. He has 20 years of experience with the broad range of spine surgery including minimally invasive surgery, complex spinal disorders such as scoliosis and kyphosis, and cervical spine disorders. During this 20 years he has noticed a dramatic increase in patients turning to surgery for treatment of neck and low back pain, but many of them not getting their desired long-term result. He therefore became increasingly interested in improvement and standardization of non-operative treatment. By developing the best aspects of non-operative treatment in an atmosphere of empowerment to maximize the body’s own healing capacity, he noticed that many fewer patients required surgery, and the ones who underwent surgery had much better long term results.

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