Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 6 , Pages 1011-1015, June 2008

The Relationship Between Repeated Epidural Steroid Injections and Subsequent Opioid Use and Lumbar Surgery

  • Janna Friedly, MD

      Affiliations

    • Departments of Rehabilitation Medicine and Comparative Effectiveness, Costs and Outcomes Research Center, Harborview Medical Center, University of Washington, Seattle, WA
    • Corresponding Author InformationReprint requests to Janna Friedly, MD, Dept of Rehabilitation Medicine and Center for Cost and Outcomes Research, University of Washington, Harborview Medical Center, Box 358740, 325 Ninth Ave, Seattle, WA 98127
    • ,
  • Isuta Nishio, MD, PhD

      Affiliations

    • Department of Anesthesiology, University of Washington, Seattle, WA
    • Department of Anesthesiology, Puget Sound VA Health Care System, Seattle, WA.
    • ,
  • Michael J. Bishop, MD

      Affiliations

    • Department of Anesthesiology, University of Washington, Seattle, WA
    • Department of Anesthesiology, Puget Sound VA Health Care System, Seattle, WA.
    • ,
  • Charles Maynard, PhD

      Affiliations

    • VA Puget Sound Health Care System Epidemiologic Research Information Center and Department of Health Services, University of Washington, Seattle, WA

Abstract 

Friedly J, Nishio I, Bishop MJ, Maynard C. The relationship between repeated epidural steroid injections and subsequent opioid use and lumbar surgery.

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.

Key Words: Injections, epidural, Low back pain, Rehabilitation, Spinal stenosis

 

 Supported by the National Institutes of Health, Rehabilitation Medicine Scientist K12 Program (grant no. 2K12HD001097-11) and the Office of Research and Development, Puget Sound VA Health Care System, Seattle, WA.

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

PII: S0003-9993(08)00168-8

doi:10.1016/j.apmr.2007.10.037

Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 6 , Pages 1011-1015, June 2008

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