Along with concerns related to misuse, new concerns about the impacts of opioid use on long-term recovery are now emerging. Two recent studies suggest that opioid use may worsen prognosis after surgery.
One of the studies involved recipients of spinal surgery. Participants who took opioids prior to surgery had poorer outcomes one year after surgery for both mental and physical measures. The more opioids participants took, the worse their outcomes. See more on this study at www.sciencedaily.com.
Another study assessed the correlation between prior opioid use and recovery from reverse shoulder arthroplasty, a form of shoulder replacement surgery. Shoulder function scores and range of motion scores improved after surgery, but patients who had used opioids prior to surgery had poorer outcomes than those who hadn’t. See more on this at www.ncbi.nlm.nih.gov.
While these studies point to poorer treatment outcomes as a pain-killer risk, they don’t tell us why this correlation might exist. One potential explanation is that patients who use opioids before surgery might simply have been in more pain than those who didn’t. The study into shoulder arthroplasty explicitly states that patients who used opioids had poorer scores preoperatively; this could simply mean that more severe conditions before surgery indicate lower improvement scores after.
However, this isn’t the only explanation possible. Use of opioids may inhibit the body’s ability to heal. This may be due to the action of the drugs on the body’s immune system. One study using mice sought to assess for a correlation between morphine administration and wound healing. Researchers found that morphine caused a delay in the normal immune system response on a cellular level following wounding, which led to delayed healing. Read more about this at www.ncbi.nlm.nih.gov.
Another rat study tested the impacts of morphine use post-operatively on bone healing in rats. Between four and eight weeks post-surgery, bone healing was significantly poorer in rats treated with morphine compared to those that were not. See more on this at www.ncbi.nlm.nih.gov.
The applicability of these latter studies to those into preoperative opioid use in humans is debatable, but they do indicate that opioid medications affect multiple systems in an organism and can have an impact on the body’s healing processes. Other potential causes of the correlation between opioid use and poorer outcomes, such as psychological factors, are also worth considering.
Patients deserve to know all possible risks associated with the treatments they may pursue. Though the exact reasons aren’t known, recent research suggests that candidates for surgery may have poorer prognoses if they use opioids before their procedures. Arm yourself with thorough knowledge of risks in order to make the best decision for back pain management.