title: Predictors of long-term opioid use among patients with painful lumbar spine conditions.
abstract: Our objective was to assess predictors of self-reported opioid use among patients with back pain due to lumbar disc herniation or spinal stenosis. Data were from the Spine Patient Outcomes Research Trial (SPORT), a multi-site observational study and randomized trial. We examined characteristics shown or hypothesized to be associated with opioid use. Using generalized estimating equations, we modeled associations of each potential predictor with opioid use at 12 and 24 months. At baseline, 42% of participants reported opioid use. Of these participants, 25% reported continued use at 12 months and 21% reported use at 24 months. In adjusted models, smoking (RR = 1.9, P < .001 at 12 months; RR = 1.5, P = .043 at 24 months) and nonsurgical treatment (RR = 1.7, P < .001 at 12 months; RR = 1.8, P = .003 at 24 months) predicted long-term opioid continuation. Among participants not using opioids at baseline, incident use was reported by 8% at 12 months and 7% at 24 months. We found no significant predictors of incident use at 12 or 24 months in the main models. In conclusion, nonsurgical treatment and smoking independently predicted long-term continued opioid use. To our knowledge, this is the first longitudinal study to assess predictors of long-term and incident opioid use among patients with lumbar spine conditions.
  
  
  CONCLUSIONS
  This longitudinal study of patients with disc herniation or spinal stenosis found that nonsurgical treatment and smoking predicted long-term self-reported opioid use. The greater risk of opioid continuation with nonsurgical therapy may be helpful in decision-making about treatment. The relationship between opioid use, smoking, and other substance use deserves further study.
authors.affiliation: Center on Implementing Evidence-Based Practice, Roudebush VA Medical Center; Department of Medicine, Indiana University School of Medicine; and Regenstrief Institute, Inc, Indianapolis, Indiana, USA. krebse@iupui.edu
authors.forename: Erin E
authors.initials: EE
authors.lastname: Krebs
authors.forename: Jon D
authors.initials: JD
authors.lastname: Lurie
authors.forename: Gilbert
authors.initials: G
authors.lastname: Fanciullo
authors.forename: Tor D
authors.initials: TD
authors.lastname: Tosteson
authors.forename: Emily A
authors.initials: EA
authors.lastname: Blood
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Carey
authors.forename: James N
authors.initials: JN
authors.lastname: Weinstein
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D001416:Back Pain / Q000175:diagnosis* / Q000188:drug therapy* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000601:surgery / Q000628:therapy; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D012306:Risk; D012907:Smoking; D013130:Spinal Stenosis / Q000150:complications* / Q000601:surgery / Q000628:therapy; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid