CHICAGO — The need for a multimodal pain management strategy that avoids opioids and includes NSAIDs may be complicated and challenging to manage but, according to a presenter here, such a protocol can be beneficial to patients long-term and lead to less use of habit-forming narcotics.
NSAIDs have pros and cons depending on the dosage and when they are used in relation to spine fusion surgery, Choll W. Kim, MD, said during a symposium at the North American Spine Society Annual Meeting.
“Spine patients have a lot of pain postoperatively. [It] is pretty striking. In an effort to decrease our reliance on these powerful narcotics, we do not have a single drug that can replace them. So, we are kind of replacing them with multimodality therapy strategies and, hopefully, you will appreciate that it is beneficial,” he said. “One of those components is the use of anti-inflammatories, and they can be used safely. Like all medications, in certain doses and in certain time periods, they are not beneficial. They have certain side effects.”
Kim proposed more surgeons adopt the same rule for NSAID use that he has followed for the past 2 years noting, “You use the normal dose for the first few days. It is reasonable.”
Choll W. Kim
He discussed studies that examined NSAID use relative to fusion surgery. Kim cited a study by Steven D. Glassman, MD, and colleagues which examined nonunion rates and found the odds ratio was five-times higher with NSAID use than without the use of anti-inflammatories.
“That is higher than smoking,” Kim said.
He also cited a meta-analysis by Quan Li, MD, and colleagues of about 1,400 patients who used NSAIDs within 2 weeks of spine fusion and showed no effect on nonunion rates if a typical dose was used.
“But, if you use a high dose, usually about four-times more than what the average person would use with osteoarthritis, that relative risk goes up to almost three-fold,” Kim said,
One area of NSAID use for spine surgery pain that still does not have well-established data, according to Kim, relates to when it is safe to resume use.
“You can probably start it as early as 8 weeks, but for sure at 12 weeks,” he said. – by Susan M. Rapp
Glassman SD, et al. Spine (Phila Pa 1976). 1998;23:834-838.
Kim CW. Anti-inflammatory medications in the setting of spinal surgery: Fusion vs. nonfusion. Presented at: North American Spine Society Annual Meeting; Oct. 14-17, 2015; Chicago.
Li Q, et al. Spine (Phila Pa 1976). 2011;doi:10.1097/BRS.0b013e3181dfd163.
Disclosure: Kim reports he receives royalties from Globus; has stock ownership in Spine View; is a consultant to Biomet, Globus, K2M and Joimax; has teaching/speaking arrangements with Globus; and receives travel expenses and research support/staff/materials from Globus.