55. Ending opioid addiction following spine surgery

BACKGROUND CONTEXT Opioid addiction is the number one health care issue in the United States with spinal ailments the leading medical condition associated with opioid addiction. Patients with chronic pain syndrome and opioid addiction going for spine surgery are at high risk for several poor outcomes, including life-long use of opioids. Current evidence-based methods to optimize patients prior to spine surgery have been: (1) transition from opioids to nonopioid medications, (2) cardiovascular exercise program, (3) smoking cessation, (4) alcohol cessation, and (5) psychotherapy to treat mood and maladaptive pain behavior. PURPOSE The authors hypothesized that an initiation of an interdisciplinary “prehab” protocol utilizing all five aforementioned modalities prior to spine surgery in patients with chronic pain syndrome and opioid addiction would optimize postoperative outcomes, including decreased pain and opioid consumption. STUDY DESIGN/SETTING Prospective and retrospective review of patients with and without an interdisciplinary “prehab” program prior to spine surgery. PATIENT SAMPLE Eighty-nine patients with prehab and 85 patients without prehab prior to spine surgery. OUTCOME MEASURES Opioid usage, visual analog scale (VAS) for axial pain and radiculopathy, EQ-5D, QALY, PHQ-9, pain castrophizing scale (PCS), and chronic pain acceptance questionnaire (CPAQ). METHODS A review from 2013 to 2017 at a single institution was performed on patients undergoing spine surgery. Inclusion criteria were patients undergoing spine surgery who had preoperative chronic pain syndrome and opioid addiction. Two cohorts were investigated which included patients going for spine surgery with and without a multidisciplinary "prehab" protocol. The protocol was the initiation of a multidisciplinary task team to preoperatively optimize patients with opioid addiction and chronic pain syndrome going for spine surgery. Collaboration was between the spine surgery division, pain management, pharmacy, psychiatry, psychology, primary care, physical therapy, and nutritionist. Patients in the "prehab" cohort underwent a preoperative optimization checklist: patients were transitioned off of opioids with utilization of nonopioid medications; patients who were smokers were enrolled in an smoking cessation program; patients who had alcohol dependence had a behavioral medicine consult with psychology; patients who were obese (BMI >35) were enrolled in a multidisciplinary weight loss program through monitored cardiovascular exercising and nutritionist consultation; and all patients had a consultation with behavioral medicine for their chronic pain syndrome to forge healthy relationships with their pain. RESULTS Demographics and case breakdown (surgery type performed) were similar between cohorts. A significantly greater amount of patients receiving prehab were opioid-free following spine surgery compared to patients without prehab (8% vs 72%, respectively, p CONCLUSIONS A multidisciplinary “prehab” program for patients with opioid addiction and chronic pain syndrome going for spine surgery is efficacious at reducing opioid addiction and pain, improving quality of life and depression, and forging a healthier relationship with pain. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.