Psychosocial risk factors predict prescription opioid usage after spine surgery



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Outcomes associated with spine surgeries are not universal. Moreover, some patients continue to remain on prescription strength opioids after surgery. Pre-surgical psychological screenings (PPS) are conducted to assess for psychosocial factors that may affect surgical outcomes. The purpose of this investigation was to examine whether patients tended to continue taking prescription pain medications shortly after spine surgery (approximately 6-months post-surgery). In addition, analyses examined whether scale scores of the MMPI-2-RF predicted a greater likelihood of remaining on prescription pain medications following spine surgery/SCS after controlling for self-reported pre-surgical medication status and pre-surgical pain levels. Patients (n = 821) were administered the MMPI-2-RF and given a pre-surgical packet of other self-report measures including pain levels, pain medications, and surgery type. Analyses were calculated to explore the incremental validity of the scale scores of the MMPI-2-RF in predicting post-surgical prescription pain medication after controlling for pre-surgical prescription pain medication status, pre-surgical baseline pain ratings, and surgery type. Using presurgical prescription pain medications prior to surgery was the strongest predictor of post-surgical prescription pain medication use. Patients who underwent a spinal fusion reported less pain at the post-operative follow-up. Higher scale scores on Demoralization (RCd) incrementally predicted post-surgical prescription pain medication use and post-operative pain after controlling for presurgical prescription pain medication use, pre-surgical pain levels, and surgery type. Somatic Complaints (RC1) also incrementally predicted higher post-operative pain after controlling for pre-surgical opioid use, surgery type, and pre-surgical pain levels. Consistent with the literature, many patients continue to use prescription strength pain medications shortly following surgical intervention for back pain. However, patients who tended to be sad, unhappy, and incapable of dealing with life circumstances pre-surgery were more likely to continue to be on prescription strength pain medications post-surgery.



Opioids, Pain, Spine Surgery, Spinal Cord Stimulator, MMPI-2-RF, Psychosocial Risk Factors, Presurgical Psychological Evaluation