Opioid Use Following Spine Surgery: Strategies for a Multimodal Approach To Pain Management

TL;DR

This paper reviews strategies to reduce opioid use after spine surgery by promoting multimodal pain management and alternative therapies.

Contribution

The paper emphasizes the need for a multimodal and individualized approach to pain management following spine surgery to reduce opioid dependence.

Findings

Non-opioid agents and nutraceuticals can reduce opioid consumption after spine surgery.

Spinal cord stimulation may help some patients but lacks clear evidence of opioid-sparing effects.

Pharmacogenomic testing could guide personalized pain management strategies.

Abstract

Chronic back pain is highly prevalent and closely associated with opioid misuse, particularly in patients undergoing spine surgery. Optimizing opioid prescribing practices and advancing alternative treatment modalities is critical to reduce opioid-related morbidity and mortality.

Despite their well-documented risks—including misuse, adverse effects, and detrimental impacts on postsurgical outcomes—opioids remain the most commonly prescribed analgesics for back pain. Spine surgery, meanwhile, is frequently followed by intense postoperative pain due to central sensitization, which often necessitates opioid use and complicates pain management. This review provides an overview of current literature on opioid prescribing trends and alternative therapies for patients undergoing spine surgery.

Following spine surgery, non-opioid pharmacologic agents and nutraceuticals can enhance analgesia and reduce opioid consumption. While erector spinae plane blocks and neuraxial techniques offer transient pain relief, their efficacy is limited by duration and potential risks. Spinal cord stimulation may benefit selected patients with back pain, although its opioid-sparing effects remain uncertain. Opioid prescribing should be limited to breakthrough pain and integrated into structured tapering strategies. Optimizing postoperative analgesia in spine surgery requires a multimodal approach, interdisciplinary collaboration, and individualized prescribing—potentially guided by emerging tools such as pharmacogenomic testing.