Medical Marijuana Won't Help Ease Opioid Crisis: Study
Title: Medical Marijuana Won't Help Ease Opioid Crisis: StudyCategory: Health NewsCreated: 7/17/2019 12:00:00 AMLast Editorial Review: 7/18/2019 12:00:00 AM
Neck and back pain caused by intervertebral disc (IVD) degeneration is a frequent cause of referral to spine surgeons. This is a multifactorial disease process caused by aging, injury, obesity, and mechanical stress. Recently, an association between IVD degeneration and diabetes has been identified, but the mechanisms underlying this relationship are unclear. Furthermore, the effects of insulin levels on cytokines known to be elevated in diabetics have not previously been delineated. Uncontrolled diabetes results in chronic systemic inflammation with increased circulating levels of IL-6 and IL-18.
Sagittal malalignment and failed surgery are established etiologies for pain in adult spinal deformity (ASD). However, pain in primary adult scoliosis with good sagittal alignment is poorly understood. Opioids may be administered to control pain in adult scoliosis but are controversial and may negatively impact patient outcome. Evaluation of two independent ASD datasets may reduce bias and help understand the impact of preop opioid therapy on postop outcomes.
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.
Opioid therapy is effective in alleviating acute postoperative pain. However, benefits of chronic opioid therapy (COT) is a contentious issue corollary to concerns relating to long-term drug dependence, tolerance and misuse. Patients with adult spinal deformities (ASD) undergoing complex, multilevel fusions often require optimized pain management strategies tailored upon disease progression and the extent of deformity correction. In alignment with a national focus on regulating lenient prescription practices, investigating epidemiological trends and risk factors associated with postoperative consumption in patients with AS...
Patient access to current best evidence primary care treatment for acute lower back remains highly problematic. Treatment pathway models have the potential to improve patient access to care, provide seamless transitions from one form of treatment to another, optimize clinical outcomes, improve cost-effectiveness and reduce progression to chronic illness /pain. A standardized protocol of hospital-based outpatient clinic chiropractic lumbar spinal manipulative therapy (CSMT) as a component of care for patients with acute lower back pain (ALBP) has been previously validated.
Opioid therapy is effective in controlling acute postoperative pain. However, the potential for abuse has been a national concern. Recent clinical trials have questioned the benefit-risk ratio of chronic opioid therapy (COT) in musculoskeletal disorders.
Lumbar degenerative disc disease contributes to chronic back pain. Mechanisms of intradiscal degeneration have been linked to genetic, metabolic and mechanical imbalance. Symptomatic relief is influenced by meaningful repair of the annulus and by nucleus supplementation.
Iatrogenic malalignment, nonunion and adjacent segment degeneration are established etiologies for pain in adult spinal deformity (ASD). However, reasons for pain among ASD patients with no prior history of surgery (nonrevision) are incompletely understood. Opioid therapy for pain is controversial and problematic.
Back pain is a pervasive public health problem with two-thirds of the population experiencing it at some point in their lives and associated with significant costs for both treatment and associated loss of productivity. When pain is persistent, traditional single service approaches to treating back pain may be insufficient, as they do not address the psychosocial factors which frequently impact an individual's pain experience.
Chronic opioid use is an emergent public health issue in the United States. Opioids are regularly prescribed to patients with adult spinal deformity (ASD) for postoperative pain. Therefore, the potential for chronic postoperative opioid use is a significant concern for patients undergoing surgery for ASD. It is important to patients, surgeons and policymakers to understand preoperative risk factors for prolonged opioid use in ASD patients who were not using opioids regularly prior to surgery.