Impact of Nerve Surgery on Opioid and Medication Use in Patients with Nerve Injuries
John M Felder, MD, Washington University, St Louis, MO and Ivica Ducic, MD, PhD, Washington Nerve Institute, McLean, VA
Introduction: Limited information is available regarding the ability of nerve surgery to affect medication use patterns in patients with chronic pain or neuropathy due to nerve injury.
Materials & Methods: A retrospective survey was distributed to all patients from a single nerve surgeon's practice between 2014-2020. Data collected included demographics, specifics of nerve injury, patient-reported disease severity, opioid and other medication use patterns before and after surgery.
Results: 189 out of 767 patients responded (24.6%). Average age was 49 years, 70.1% male, 29.9% female. 59.9% had suffered a physical trauma, 31.6% were precipitated by previous surgery. Prior to treatment, symptoms were present for: >10yrs 9.6%, 5-10 years 8.6%, 3-5 years 23.5%, 1-2 years, 24.6%, 6-12 months 20.3%, 3-6 months 9.6%, <3 months 3.2%. 84% reported profound severity of symptoms at presentation, 15.5% moderate severity. Average Likert scale severity score was 7.9/10.
The total number of medications used daily before nerve surgery was: 0 (11.8%), 1-2 (29.9%), 3-4 (31%), 5-6 (15%), 7-8 (7%), 9-10 (2.1%), 11-12 (1.6%), >12 (1.6%). 97.6% of patients reported that medications did not resolve their problem, with an average effectiveness of 2.8/10. After surgery patients reported that their use of all medications was: completely eliminated (35.2%), significantly reduced (18.1%), moderately reduced (12.1%), somewhat reduced (7.7%), not affected (24.2%), made worse (2.7%).
Total daily opioid medication use before surgery was: 0 (48.1%), 1-3 (37.4%), 4-6 (12.3%), 7-9 (2.1%). 92.8% of patients reported that narcotic medications did not resolve their problem. Patients rated the effectiveness of opioid medications in general at an average of 3.8/10. Of patients who took opioids regularly, 51% reported a negative effect of these medications on daily or professional activities
After surgery patients reported that their use of opioid medications was: completely eliminated (62.6%), significantly reduced (5.7%), moderately reduced (5.2%), somewhat reduced (5.7%), not affected (18.4%), made worse (2.3%).
Conclusions: Untreated peripheral nerve injuries lead to ongoing neuropathy and chronic pain, explaining why medications are mostly ineffective in eliminating symptoms. In this study, nerve surgery targeting the anatomical source of symptoms effectively reduced both opioid and non-opioid medication use. Additional analysis will be presented supplementing this report.
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