Chronic Work Loss Due to Narcotic Use
Chronic low back pain can lead to disability and loss of work. Some doctors prescribe strong (narcotic) pain relievers called opioids in an effort to help people get back to work. But critics of this approach say there's no proof that opioid use improves outcomes. In fact, there's some evidence that opioid therapy may actually be linked with increased risk of work loss.

Experts in the area of social science tell us that people who lose their jobs can suffer severe problems. They start out in a state of fearful distress that quickly becomes a despairing attitude of giving up. The loss of income makes things even worse. To test the effect of opioid use on work loss, two groups of Worker's Compensation claimants were compared.

Everyone included in the study had filed a Worker's Comp claim for low back pain. One group was provided with opioid therapy. Some were taking weak (Class III or IV) opioids. Others were given strong (Class II) opioids. The opioid group was further divided into two subgroups based on whether or not they took opioids for up to 90 days or for more than 90 days. The second (reference) group had filed a Worker's Comp claim for low back pain but no one in the group was taking opioid-based medications.

Analysis of the data collected for the two main groups showed a significant link between opioid use and work loss. Workers taking any kind of opioid were 11 to 14 times more likely to suffer work loss compared to the reference (no opioid) group. Workers using strong (Class II) opioids were six times more likely to experience chronic work loss. The time frame used for this study was 90 days or more. And the overall costs for the opioid group was much higher than for the nonopioid group.

The authors concluded that the use of opioids may be a factor in work loss. The data here confirmed that the odds of chronic disability and work loss were much higher for claimants taking any strength opioids. But the severity of pain could be just as important. And pain translates to disability when it interferes with family life, sleep, and everyday activities. Adding opioids as a means of controlling pain doesn't solve these problems.

The authors point out some of the advantages and disadvantages of a study like this. Using data from a Worker's Comp claim database allows for long-term follow-up at a relatively small cost. The patients represent the average worker. Other studies from academic medical centers may have a better response to treatment just because they are in a special study. That seems to boost their motivation (moreso than for people in a Worker's Comp claim).

The disadvantages are many and varied. For example, patients are classified based on reimbursement. The way the data is collected doesn't make it possible to assess or measure the results of treatment. This approach doesn't always give an accurate picture of what's wrong with the patient. Likewise, no one asks the worker (claimant) how severe their back pain is or if treatment relieved the pain. Other important information may also be missing from the files.

For example, some workers may return to their jobs even if pain is still present. Measuring work loss can be a challenge. This is especially true if the claim isn't settled. Workers may disappear from the system because disability prevents them from returning to their former job or taking another one.

Future studies are needed to review the relationship of opioid use with chronic work loss. Designing studies with fewer confounding (confusing) factors may help shed more light on this topic. Studying groups who are not Worker's Comp claimants might reveal a different story altogether.
Ernest Volinn, et al. Opioid Therapy for Nonspecific Low Back Pain and the Outcome of Chronic Work Loss. In PAIN. April 2009. Vol. 142. No. 3. Pp. 194-201.