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Effects of the 2016 CDC opioid prescription guidelines on opioid use and worker compensation case length in patients with back pain

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Abstract

Background

Narcotic consumption in the workers’ compensation population contributes to prolonged case duration, worse clinical outcomes, and opioid dependence. In 2016, the CDC provided recommendations guiding clinicians on prescribing opioids to adult patients with chronic pain. The objective of our study was to evaluate a cause-and-effect relationship between narcotic consumption and worker compensation claim length before and following guideline revision.

Methods

An administration database was retrospectively queried to identify patients evaluated for spine-related workers’ compensation claimants from 2011 to 2021. Data was recorded for age, sex, BMI, case length, narcotic usage, and injury location. Cases were grouped together by exam date before (2011–2016) and after (2017–2021) the 2016 CDC opioid guideline revision.

Results

Six hundred twenty-five patients were evaluated. Males composed 58% of the study population. From 2011 to 2016, narcotic consumption was reported in 54% of subjects versus no narcotic consumption in 46% of subjects (135 cases). From 2017 to 2021, narcotic consumption decreased to 37% (P = 0.00298). Prior to the guideline revision, mean case length was 635 days. Following CDC guideline revision, there was a significant decline in mean case length duration to 438 days (31% reduction) (P = 0.000868).

Conclusion

This study demonstrates that following revised opioid prescription recommendations by the CDC in 2016, there was a statistically significant decline in opioid consumption and workers’ compensation case length duration. Opioid use may influence prolonged worker disability and delayed return to work.

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Abbreviations

BMI:

Body mass index

SD:

Standard deviations

MCID:

Minimum clinically important difference

CDC:

Center for Disease Control

NSAID:

Non-steroidal anti-inflammatory drugs

LBP:

Low back pain

BMI:

Body mass index

RTW:

Return to work

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Authors and Affiliations

  1. Department of Neurological Surgery, Rush University Medical Center, 1725 W. Harrison St., Suite 855, Chicago, IL, 60612, USA

    Anthony M. Alvarado & Harel Deutsch

  2. Northwestern University, Chicago, IL, USA

    Ethan Chung

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  1. Anthony M. Alvarado
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  2. Ethan Chung
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Contributions

Anthony Alvarado: helped with editing/proofreading/writing. Ethan Chang: helped with editing/proofreading/writing. Harel Deutsch: helped with editing/proofreading/writing.

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Correspondence to Anthony M. Alvarado.

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This article does not contain any studies with human participants or animals performed by any of the authors. This study was supported by the Neurosurgery Research & Education Foundation (2023-24) Clinical Fellowship Grant.

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The authors declare no competing interests.

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Alvarado, A.M., Chung, E. & Deutsch, H. Effects of the 2016 CDC opioid prescription guidelines on opioid use and worker compensation case length in patients with back pain. Acta Neurochir 165, 2139–2144 (2023). https://doi.org/10.1007/s00701-023-05694-4

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  • DOI: https://doi.org/10.1007/s00701-023-05694-4

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