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The relationship between repeated epidural steroid injections and subsequent opioid use and lumbar surgery.

Friedly J, Nishio I, Bishop MJ, Maynard C

Department of Rehabilitation Medicine, Costs and Outcomes Research Center, Harborview Medical Center, University of Washington, Seattle, WA 98127, USA. friedlyj@u.washington.edu

OBJECTIVES: To evaluate whether the use of epidural steroid injections (ESIs) is associated with decreased subsequent opioid use in patients in the Department of Veteran's Affairs (VA) and to determine whether treatment with multiple injections are associated with decreased opioid use and lumbar surgery after ESIs. DESIGN: VA patients undergoing ESIs during the study period for specific low back pain (LBP) diagnoses were identified, and lumbar surgery and opioid use were examined for 6 months before and after ESI. SETTING: National VA administrative data. PARTICIPANTS: U.S. veterans (retrospective data analysis). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Opioid use and lumbar surgery after ESIs. RESULTS: During the 2-year study period, 13,741 different VA patients underwent an ESI for LBP. The majority of patients were using opioids before their ESIs (64%), as were the majority after their ESIs (67%). Of patients not on opioids before the ESIs, 38% were prescribed opioids afterward, whereas only 16% of people on opioids before the ESIs stopped using opioids afterward. Patients who received more than 3 injections were more likely than patients receiving fewer injections to start taking opioids after ESIs (19% vs 13%, P<.001) and to undergo lumbar surgery after ESIs (8.7% vs 6.3%, P=.003). CONCLUSIONS: Opioid use did not decrease in the 6 months after ESIs. In this population, patients who received multiple injections were more likely to start taking opioids and to undergo lumbar surgery within the 6 months after treatment with ESIs. These findings are concerning because our data suggest that ESIs are not reducing opioid use in this VA population.

Published 27 May 2008 in Arch Phys Med Rehabil, 89(6): 1011-5.
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