title: Is chronic opioid use a negative predictive factor for response to cervical epidural steroid injections?
abstract: BACKGROUND
  Cervical epidural steroid injections (ESIs) are often used to treat patients with neck and upper extremity pain associated with a cervical radiculopathy. The effect of chronic opioid use in cervical radiculopathy patients managed with ESIs is unknown; past studies suggest that these patients may behave differently than opioid naïve patients. The purpose of this study is to determine the effect of chronic (greater than 6 months) opioid use on the immediate outcome of cervical ESIs.
  
  
  METHODS
  A two year retrospective chart review identified 22 consecutive patients with cervical radiculopathy who underwent a single level interlaminar cervical ESI, main outcome variable was > 50% pain relief on VAS at follow up. Inclusion factors were unilateral disc protrusion, exclusion factors were severe central canal or foraminal stenosis, spondylolithesis, spinal instability, cord edema, or with multi-level disc protrusions.
  
  
  RESULTS
  Using a linear logistic regression analysis on both patient demographics and physical exam measures, the most significant explanatory model was the use of opiates at the time of injection; 70% of opioid naïve patients had a favorable outcome while only 20% of patients managed with chronic opioids had relief (p= 0.06).
  
  
  CONCLUSIONS
  Patients managed with opioids chronically may respond in a different manner to ESIs when compared to opioid naïve patients.
authors.affiliation: Kaiser Permanente Santa Clara Medical Center, Department of Physical Medicine and Rehabilitation, Santa Clara, CA, USA.
authors.forename: Dhiruj
authors.initials: D
authors.lastname: Kirpalani
authors.forename: Raj
authors.initials: R
authors.lastname: Mitra
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000188:drug therapy*; D010147:Pain Measurement; D011843:Radiculopathy / Q000188:drug therapy*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000701:Analgesics, Opioid