Opioids, musculoskeletal disorders, and work-related outcomes
Musculoskeletal disorders (MSDs) such as strains, sprains, fractures, and arthritis are a common cause of work disability and absenteeism. Current guidelines suggest that opioid medications should be prescribed for MSDs only when pain is severe and unresponsive to non-opioid analgesics. However, in some cases best practice guidelines are not being followed and opioids are overprescribed for MSDs, potentially contributing to work disability.
To explore the relationship between opioid prescription for MSDs and work disability, UTCSP members Dr. Andrea Furlan, Nancy Carnide, and colleagues conducted a systemic review of the literature. The authors screened over 3000 potential articles, of which only five articles met the criteria of examining working aged adults with MSDs, tracking opioids prescribed within 12 weeks of MSD onset, and reporting work-related outcomes, such as disability or absenteeism.
Analysis of these five studies found that receiving an opioid prescription early in an MSD was positively correlated with disability claims at six months. A greater dosage and duration of opioid use was also positively correlated with longer time away from work due to disability. Unfortunately, the authors found that no study accurately accounted for all confounding variables, and thus definitive conclusions could not be drawn. In the absence of rigorously designed studies, it is impossible to determine whether best practices need to be modified, or if they are indeed the best course of action. The authors outlined how this lack of evidence creates a dilemma whereby the clinician cannot be sure how best to help their patients seek relief and maintain quality of life. As a result, the authors call for physicians to be cautious and vigilant in prescribing opioids for MSDs, and for future studies to thoroughly investigate this critical question.
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Carnide et al. (2016). Early Prescription Opioid Use for Musculoskeletal Disorders and Work Outcomes: A Systematic Review of the Literature. The Clinical Journal of Pain, doi:10.1097/AJP.0000000000000452.