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Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
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Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
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Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
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Persistent Opioid Use After Spine Surgery: A Prospective Cohort Study.

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Many patients continue opioid use after spine surgery for various reasons, not just pain. Frequent withdrawal symptoms highlight the need for better opioid tapering strategies post-surgery.

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Area of Science:

  • Orthopedics
  • Pain Management
  • Pharmacology

Background:

  • Opioid prescriptions are common post-surgery, with many patients continuing use long-term.
  • Spine surgery is a high-risk procedure for persistent opioid use.
  • Limited understanding exists regarding the reasons for continued opioid use after spine surgery.

Purpose of the Study:

  • To identify patient-reported reasons for persistent opioid use after elective spine surgery.
  • To assess the incidence of opioid withdrawal symptoms.
  • To characterize post-discharge pain management care seeking.

Main Methods:

  • Prospective cohort study of 300 patients undergoing spine surgery.
  • Data collected via REDCap surveys at 3 and 6 months post-surgery.
  • Included baseline characteristics, opioid consumption, reasons for use, withdrawal symptoms, and care seeking.

Main Results:

  • Postoperative opioid use increased from 53% pre-surgery to 60% at 3 months for prior users.
  • Reasons for use included surgery-related pain (53%), combined reasons (37%), and non-surgery related (10%).
  • 33% experienced withdrawal symptoms, linked to continued opioid use (P < 0.001); 52% sought post-discharge pain care.

Conclusions:

  • Opioid use post-spine surgery extends beyond pain management.
  • Withdrawal symptoms are common despite discharge tapering plans.
  • Further research is needed to optimize safe and effective opioid tapering for spine surgery patients.