Back Pain in the Era of Opioid Restriction and Implications for Neurosurgeons Based on Qualitative Findings From a Rural State

Cara L Sedney; Uchenna Okakpu; Patricia Dekeseredy; Robin A Pollini; Joshua M Rosenow; Treah Haggerty

doi:10.7759/cureus.57389

Back Pain in the Era of Opioid Restriction and Implications for Neurosurgeons Based on Qualitative Findings From a Rural State

Cureus. 2024 Apr 1;16(4):e57389. doi: 10.7759/cureus.57389. eCollection 2024 Apr.

Authors

Cara L Sedney¹, Uchenna Okakpu², Patricia Dekeseredy¹, Robin A Pollini³, Joshua M Rosenow⁴, Treah Haggerty⁵

Affiliations

¹ Neurosurgery, West Virginia University, Morgantown, USA.
² Medicine, West Virginia University, Morgantown, USA.
³ Behavioral Medicine and Psychiatry, Epidemiology and Biostatistics, Public Health, West Virginia University, Morgantown, USA.
⁴ Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA.
⁵ Family Medicine, West Virginia University, Morgantown, USA.

Abstract

Historically, back pain has been an inciting complaint for the initiation of opioids. Aggressive marketing of opioids to treat back pain coupled with the initiation of pain being treated as "the fifth vital sign" contributed to the emerging opioid crisis in the USA. West Virginia (WV) has long been considered the epicenter of the crisis. In 2018, the WV legislature passed a bill that placed prescribing limits on opioids. Our group set out to investigate the impacts of opioid prescribing restrictions through a sequential, mixed methods study evaluating prescription trends and stakeholder experiences. These stakeholder experiences generated emergent themes regarding the evolution of the opioid crisis up to and beyond the implementation of the bill, which is of relevance to neurosurgeons and back pain treatment. This study explores those findings for a neurosurgical audience. This study consisted of open-ended, semi-structured interviews with a purposive sample of 50 physicians, pharmacists, and patients in WV. Interviews were recorded and transcribed verbatim. Content analysis was utilized as the methodological orientation. Five theoretical domains relevant to the treatment of back pain emerged, describing the prevalence of opioid use, barriers to access care, the importance of opioids for function in resource-poor rural areas, disconnected and siloed care, and patient views on the impacts of pain care gaps and solutions. Spinal pain care in rural WV is complex due to identified challenges. Care siloing factors in suboptimal spinal pain care. Future work should define, implement, and assess the real-world effectiveness of treatment paradigms for the full spectrum of surgical and non-surgical back pain complaints. Neurosurgeons should be present in this arena.

Keywords: chronic lower back pain; general neurosurgery; non-surgical treatment; opioids use; rural areas; substance use disorder (sud); treating low back pain.

Grants and funding

Funding for this study was provided by NIH-NIDA Grant; 1R21DA049861-01. NIH-NIDA had no further role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. Research reported in this publication was supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award Number 5U54GM104942-05. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.