Iatrogenic disability and narcotics addiction after lumbar fusion in a worker's compensation claimant

Abstract

STUDY DESIGN: Case report. OBJECTIVE: Describe a case of chronic occupational low back pain with various treatments of questionable efficacy, leading to prolonged disability, iatrogenic narcotic addiction, and opioid-induced hyperalgesia. SUMMARY OF BACKGROUND DATA: Concerns about narcotics and other questionable treatments for chronic low back pain are increasing, especially in those with work-related conditions. METHODS: Medical record review. RESULTS: The patient had significant, persistent low back symptoms, but good function at work and home. He underwent lumbar fusion to address persistent pain, and subsequently developed failed back surgery syndrome. He was prescribed increasing amounts of opioid analgesics and was recommended for an intrathecal morphine pump, without evaluation of the safety or efficacy of his current regimen. Subsequently, he was hospitalized for opioid detoxification and substance abuse treatment. CONCLUSION: Patients with chronic low back pain are at risk for receiving ineffective and potentially harmful treatment. A focus on restoring function instead of complete pain relief may lead to better outcomes in these patients.