Is chronic opioid use a negative predictive factor for response to cervical epidural steroid injections?

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 naive 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 naive 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 naive patients

Keywords : administration & dosage,Adrenal Cortex Hormones,Adult,Aged,Analgesics,Analgesics,Opioid,analysis,Cervical Vertebrae,drug therapy,Edema,Female,Hormones,Humans,Injections,Injections,Epidural,Male,methods,Middle Aged,Neck,Neck Pain,Pain,Pain Measurement,Patients,Radiculopathy,Regression Analysis,rehabilitation,Retrospective Studies,Sensitivity and Specificity,therapeutic use,Time,Treatment Outcome,Upper Extremity,, Chronic,Opioid,Negative, stem cell treatment for back pain uk

Date of Publication : 2011

Authors : Kirpalani D;Mitra R;

Organisation : Kaiser Permanente Santa Clara Medical Center, Department of Physical Medicine and Rehabilitation, Santa Clara, CA, USA

Journal of Publication : J Back Musculoskelet Rehabil

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/21849725

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