Purchases of analgesics before and after spine surgery – register based study of 152,829 Finnish patients with 15-year follow-up

Abstract

Purpose: The aim of the study was to assess the preoperative and postoperative analgesic purchase proportions one year before and three years after spine surgery in a comprehensive nationwide Finnish PERFECT database, which combines information from national databases on hospital visits, prescriptions for medication, and death. Methods: We identified 152,829 spine operated patients whose indication for surgery was degenerative disc disease (DDD), disc herniation (DH), spinal stenosis (SS), spondylolysis or spondylolisthesis (SPL). We retrieved their analgesic purchases from the prescription register of the Finnish Social Insurance Institution. The proportion of neuropathic pain medication, NSAID, opioid and acetaminophen buyers were observed for the period of 15 years before and after spine surgery to assess the number of prescribed analgesic purchases. Analgesic purchases one year before surgery and at the time of surgery were compared to purchases three years after surgery. Results: Analgesic purchases decreased after all operation types when the immediate preoperative purchase level was compared to the level three years after surgery. When the comparison was made between a year before surgery and three years after surgery, the proportion of neuropathic pain medication buyers increased from 5 to 11% to 7–13%, NSAID buyers 4–13% to 5–15% and DDD, DH and SS patients buying opioids from 6 to 12% to 7–14%. The proportion of acetaminophen buyers decreased from 22 to 34% to 18–24% and SPL patients buying opioids from 14% to 12%. Conclusions: Spine surgery decreased the purchases of analgesics compared to the immediate preoperative level, but postoperative purchases remained higher than preoperative if years before and after surgery are considered.