Early opiod use and longterm disability in workers

[dc2md]

Here's an article in a recent Spine journal I came across. Basically, prescription of opioids for acute LBP in workers increases the chance they'll have long-term disability.
http://www.spinejournal.com/pt/re/spine/abstract.00007632-200801150-00014.htm;jsessionid=HWDdVRyHglQQPJdNGNtkK2NQyP81ZyGD6cx32J50BH8Pp9N251SX!-1160354173!181195628!8091!-1

Coincidence? Confounding? Should more conservative methods be used first (manipulation, non-opioids like NSAIDs, interferential current)??

-chris

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[PMR 4 MSK]

From everything I've read on WC back injuries, including Waddell's recent comments, the worst thing you can do for a back injury patient is to send them home, take them off work, feed them opioids and pay them for it. Who would want to go back to work when you have that?

The study showed giving opioids in the first 6 weeks doubled the chance of disability at 1 year. The problem is this is a retrospective study, and does not appear to take into account patient motivation for the opioids or any prior use of opioids.

Always be as conservative as you can with an early WC injury. Most get better despite anything we do to them. Pschosocial factors seem to be the biggest predictors of return to work anyway.