Dose and duration of opioid use in propensity score matched, privately insured opioid users with and without spinal cord injury

Arch Phys Med Rehabil, 2018 · DOI: 10.1016/j.apmr.2017.12.004 · Published: May 1, 2018

Simple Explanation

This study compares opioid use in people with spinal cord injuries (SCI) to those without, using a matched control group to account for other factors. The aim was to see if there are differences in how long and at what doses opioids are used. The study found that people with SCI were more likely to use opioids for longer periods and at higher doses compared to the control group. This suggests a greater risk of dependence or adverse effects for those with SCI. Among individuals with SCI, those with lumbar/sacral injuries tended to have a longer supply of high-dose long-acting opioids compared to those with injuries in the thoracic or cervical regions.

Study Duration

2012-2013

Participants

1,454 opioid users with SCI and 1,454 propensity score matched opioid users without SCI

Evidence Level

Quasi-experimental analysis of archival data

Key Findings

1
Persons with SCI were significantly more likely to be long-term users of low-dose short-acting opioids (p<0.0001) compared to matched controls.
2
Individuals with SCI were more likely to be prescribed high average daily morphine equivalents of long-acting opioid prescriptions (OR=2.59 p<0.0001) than controls.
3
Among persons with SCI, those with lumbar/sacral injuries had more days’ supply of high-dose long-acting opioids than did persons with thoracic or cervical injuries.

Research Summary

This study compared opioid utilization patterns between individuals with SCI and a propensity score matched control group, finding significant differences in opioid usage. The research revealed that individuals with SCI were more likely to be long-term users of low-dose, short-acting opioids and were also more likely to be prescribed high doses of long-acting opioids compared to controls. Among those with SCI, individuals with lumbar/sacral injuries had a greater supply of high-dose, long-acting opioids, emphasizing the importance of tailored pain management strategies.

Practical Implications

Clinical Practice Guidelines

Findings should be considered in the development of practice guidelines for alternate pain management options or opioid dependence interventions for persons with SCI.

Careful Monitoring of Opioid Use

Clinicians working with patients with SCI need to carefully monitor opioid use and consider alternative interventions for pain management.

Alternative Pain Management

Suggested alternatives to opioid interventions include physiotherapy, posture/wheelchair adjustments, antispasmodics, and antibiotics.

Study Limitations

1
Uncertainty whether persons took their opioid prescriptions as prescribed.
2
Lack of SCI-level specific diagnostic codes for 50.89% of persons in the SCI cohort, which limited statistical power.
3
The current findings reflect patterns of opioid utilization among persons who have private insurance.

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