Thursday, September 27, 2018 1:05 PM–2:05 PM Understanding Anxiety and Depression when Performing Spine Surgery: 120. Preoperative psychological factors significantly add to the predictability of chronic narcotic use: a two-year prospective study

Abstract

BACKGROUND CONTEXT Narcotic therapy can be effective for treating chronic pain, but research has established that it is commonly associated with addiction and overdose. Concerns with chronic narcotic use are well established in the literature. Understanding the risk of developing chronic narcotic use in the preoperative period may be aided through investigation of psychological measures. PURPOSE To determine if psychological factors are significant predictors of narcotic use two years following thoracolumbar spine surgery. STUDY DESIGN/SETTING A prospective observational study using Canadian Spine Outcomes and Research Network (CSORN) data alongside validated psychological measures. PATIENT SAMPLE Consecutively enrolled adult patients having undergone thoracolumbar spine surgery (N=191). Those having undergone previous spine surgery were excluded. OUTCOME MEASURES Baseline measures of interest included the Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia, Multidimensional Scale for Perceived Social Support, Chronic Pain Acceptance Questionnaire (CPAQ-8), Oswestry Disability Index (ODI), Numeric Rating Scales for back and leg pain (NRS-B/L), SF-12’s Mental Component Summary (MCS), narcotic use and demographic variables. The postoperative measure of interest was narcotic use at two-year follow-up. METHODS Baseline measures were collected at initial clinical assessment. Narcotic use was collapsed into binary categories of use and no use. Descriptive statistics were run. Chi Square analysis was used for categorical variables and an ANOVA for continuous variables. Significant variables were built into a binary logistic regression to determine predictors of postoperative narcotic use. Significance was set at α RESULTS A total of 27.23% of the sample were using narcotics two years after surgery. The regression model included ODI, NRS-Leg, time with condition, chief complaint, preoperative drug use, gender, MCS, PCS subscale helplessness and CPAQ subscale pain willingness and was significant χ2 =(13, N=191) 54.99; p=.000. The model accounted for 39.6% of the variance in narcotic use and correctly predicted in 79.7% of cases. Psychological variables accounted for 9.6% of the variance over and above the other predictors. CONCLUSIONS Psychological factors in the preoperative period are significant predictors of narcotic use two years postoperatively. The likelihood of chronic narcotic use following surgery is predictable and therefore may be proactively managed. Identifying predictors of chronic postsurgical narcotic use can enable surgeons to provide their patient with preventative resources. Managing chronic narcotic use is imperative, as it is central to the patient's overall health and quality of life. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.