Predictors of Weeks to Opioid Cessation after Lumbar Fusion: A Prospective Cohort Study.

BACKGROUND: Although the use of prescription opioid analgesics to treat acute, postoperative pain is a well-established practice, the role of opioids in the management of persistent, postoperative pain remains ill-defined. Nevertheless, high rates of long-term opioid use following lumbar fusion have been reported. AIM: The goal of this prospective, longitudinal study was to identify predictors of weeks to opioid cessation in a cohort of patients undergoing elective lumbar fusion. METHODS: Prior to surgery, participants self-reported demographic and clinical data and completed a validated measure of pain catastrophizing. Three months following surgery, participants self-reported prescription opioid use. RESULTS: Forty-four percent (n = 22) of participants reported opioid use 12 weeks following lumbar fusion. Bivariate analysis identified a strong correlation between weeks to opioid cessation and preoperative opioid use, r = .46, and a moderate correlation between weeks to opioid cessation and disability, r = .29. The multiple regression model predicting weeks to opioid cessation from age, sex, employment status, educational level, preoperative pain intensity, preoperative opioid use, disability status, and pain catastrophizing was significant, F(8, 38) = 2.254, p = .044, and accounted for 18% of the variance. Among preoperative patient characteristics, only preoperative opioid use significantly predicted weeks to opioid cessation, ß = .466; p = .005. CONCLUSION: Thus, nurses and nurse practitioners may be able to identify patients at risk for long-term opioid use following lumbar fusion by screening patients for preoperative opioid use.

The Biopsychosocial Model of Low Back Pain and Patient-Centered Outcomes Following Lumbar Fusion.

Lumbar fusion is a surgical procedure performed to eliminate painful motion in a spinal segment by joining, or fusing, two or more vertebrae. Although the surgery has a high rate of producing radiographic fusion, many patients report pain, functional disability, an inability to return to work, and prolonged opioid pain reliever use following the procedure. Using the biopsychosocial model of low back pain as a framework, this review of the literature describes the biological, psychological, and social factors that have been associated with these negative outcomes. The findings suggest that at least some of the variability in postoperative outcomes may be due to preoperative patient characteristics, and evidence the theorized relationship between biopsychosocial factors and low back disability. The review also highlights a gap in the literature regarding biopsychosocial predictors of prolonged opioid use following lumbar fusion.

Perception of Nursing Education Uses of Second Life by Graduate Nursing Students.

Although virtual reality platforms, such as Second Life, have been used in academic settings for more than a decade, little is known about how students perceive or adapt to this technology. This article presents the results of a research study that examined the experiences and perceptions of graduate nursing students as they explored the educational applications of Second Life. The students created avatars, interacted with one another in the virtual world, explored healthcare and educational uses, and maintained a reflective blog (online journal) of their experiences. Conventional content analysis was used to analyze the reflective blogs, and four themes were identified: (1) mastering Second Life, (2) technological challenges, (3) social interaction, and (4) knowledge dissemination. The results support the use of virtual reality in education, as even novice graduate students were able to overcome initial challenges and learn to navigate within a virtual world.