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Pre-Operative Opioid Prescribing Increases the Risk of Chronic Opioid Use After Lumbar Decompression Surgery
Nam V Huynh1, Darcy Fay1, Aaron J Buckland1,2,3
1Spine and Scoliosis Research Associates Australia, Windsor, VIC, Australia.
Global Spine Journal
|November 10, 2025
Summary
Pre-operative opioid use significantly increases the need for and duration of opioid use after lumbar decompression surgery. Minimizing pre-operative opioid prescriptions is crucial for reducing long-term opioid dependence in these patients.
Area of Science:
- Neurosurgery
- Pain Management
- Health Outcomes Research
Background:
- Pre-operative opioid prescribing is a growing concern in spine surgery.
- Understanding its impact on post-operative opioid use and patient outcomes is critical.
Purpose of the Study:
- To analyze the effects of pre-operative opioid prescribing on chronic opioid use after lumbar decompression.
- To evaluate the impact on patient-reported outcomes (PROMs).
Main Methods:
- Retrospective cohort study of 254 patients undergoing 1-2 level lumbar decompression.
- Comparison of opioid-naïve versus opioid-sensitized patients.
- Regression analyses to identify predictors of post-operative opioid use.
Main Results:
- Opioid-sensitized patients required 3x more post-operative MME (morphine milligram equivalents) at 6 months.
- Pre-operative opioid use >3 months significantly increased the risk of post-operative opioid use (OR 13.4-27.4).
- Despite higher opioid use, post-operative PROMs were similar between groups.
Conclusions:
- Pre-operative opioid prescribing is a strong predictor of increased post-operative opioid requirements and chronic use.
- Minimizing pre-operative opioid exposure may reduce long-term opioid use after lumbar decompression.
- Timely referral for non-opioid pain management strategies is recommended.
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