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  • Title: Is chronic opioid use a negative predictive factor for response to cervical epidural steroid injections?
    Author: Kirpalani D, Mitra R.
    Journal: J Back Musculoskelet Rehabil; 2011; 24(3):123-7. PubMed ID: 21849725.
    Abstract:
    BACKGROUND: Cervical epidural steroid injections (ESIs) are often used to treat patients with neck and upper extremity pain associated with a cervical radiculopathy. The effect of chronic opioid use in cervical radiculopathy patients managed with ESIs is unknown; past studies suggest that these patients may behave differently than opioid naïve patients. The purpose of this study is to determine the effect of chronic (greater than 6 months) opioid use on the immediate outcome of cervical ESIs. METHODS: A two year retrospective chart review identified 22 consecutive patients with cervical radiculopathy who underwent a single level interlaminar cervical ESI, main outcome variable was > 50% pain relief on VAS at follow up. Inclusion factors were unilateral disc protrusion, exclusion factors were severe central canal or foraminal stenosis, spondylolithesis, spinal instability, cord edema, or with multi-level disc protrusions. RESULTS: Using a linear logistic regression analysis on both patient demographics and physical exam measures, the most significant explanatory model was the use of opiates at the time of injection; 70% of opioid naïve patients had a favorable outcome while only 20% of patients managed with chronic opioids had relief (p= 0.06). CONCLUSIONS: Patients managed with opioids chronically may respond in a different manner to ESIs when compared to opioid naïve patients.
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