Novel objective-subjective pain assessment score results in decreased opioid prescription after elective spine surgery: a prospective pilot study.

Abstract

Opioid dependence after spine surgery is a major contributor to the opioid epidemic in the United States. Current pain assessment tools are largely subjective, linking patient satisfaction to reported pain and encouraging liberal opioid prescribing. Incorporating objective criteria into pain evaluation may improve prescribing practices while maintaining patient satisfaction. The OBSUB scale, a 10-point tool combining subjective pain scores (points 1-5) with objective signs (points 6-9: autonomic activation, avoidance behaviors, postural guarding, and distraction) plus a point for pain exaggeration, was implemented in 44 patients over 3 months. Postoperative analgesics were prescribed progressively according to the WHO analgesic ladder, with emphasis on non-opioid alternatives and staff education. Mean daily Morphine Milligram Equivalents (MME) were recorded for four intervals: 30 days preoperatively, and 0-30, 31-60, and 61-90 days postoperatively. Compared to institutional pre-intervention averages, mean daily MME decreased by 53.2% in the first postoperative month (P = .30), 32.2% in the second month (P = .0040), and 91.8% in the third month (P = .0085). At 90 days, 76% of patients were no longer prescribed opioids compared to 48% prior to intervention. Despite more restrictive prescribing, patient satisfaction increased by 27% based on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) scores. The OBSUB scale, integrating objective with subjective pain measures, effectively reduced postoperative opioid prescriptions without compromising patient satisfaction. This approach offers a promising strategy to mitigate opioid dependence after spine surgery and warrants validation in larger multicenter trials.