{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T06:45:46Z","timestamp":1792737946773,"version":"4.5.0"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2019,7,5]],"date-time":"2019-07-05T00:00:00Z","timestamp":1562284800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurosurg.","NEUROS"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>The opioid epidemic continues to worsen with a concomitant increase in opioid-related mortality. In response, the Department of Defense and Veterans Health Agency recommended against the use of long-acting opioids (LAOs) and concurrent use of opioids with benzodiazepines. Subsequently, we eliminated benzodiazepines and LAOs from our postoperative pain control regimen.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To evaluate the impact of removing benzodiazepines and LAOs on postoperative pain in single-level transforaminal lumbar interbody fusion (TLIF) patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective cohort study of single-level TLIF patients from February 2016-March 2018 was performed. Postoperative pain control in the\u00a0+\u00a0benzodiazepine cohort included scheduled diazepam with or without LAOs. These medications were replaced with nonbenzodiazepine, opioid-sparing adjuncts in the \u2212benzodiazepine cohort. Pain scores, length of hospitalization, trigger medication use, and opioid use and duration were compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Among 77 patients, there was no difference between inpatient pain scores, but the -benzodiazepine cohort experienced a faster rate of morphine equivalent reduction (\u221218.7%, 95% CI [\u22121.22%, \u221236.10%]), used less trigger medications (\u22121.55, 95% CI [\u22120.43, \u22122.67]), and discharged earlier (0.6 d; 95% CI [0.01, 1.11 d]). As outpatients, the \u2212benzodiazepine cohort was less likely to receive opioid refills at 2 wk (29.2% vs 55.8%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.021) and 6 mo postoperatively (0% vs 13.2%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.039), and was less likely to be using opioids by 3 mo postoperatively (13.3% vs 34.2%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.048).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Replacement of benzodiazepines and LAOs in the pain control regimen for single-level TLIFs did not affect pain scores and was associated with decreased opioid use, a reduction in trigger medications, and shorter hospitalizations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuros\/nyz232","type":"journal-article","created":{"date-parts":[[2019,5,16]],"date-time":"2019-05-16T23:17:15Z","timestamp":1558048635000},"page":"717-723","source":"Crossref","is-referenced-by-count":7,"title":["Protocolization of Post-Transforaminal Lumbar Interbody Fusion Pain Control with Elimination of Benzodiazepines and Long-Acting Opioids"],"prefix":"10.1227","volume":"86","author":[{"given":"Jason H","family":"Boulter","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian P","family":"Curry","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas S","family":"Szuflita","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles A","family":"Miller","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Spinelli","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John J","family":"Delaney","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris J","family":"Neal","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J","family":"Spevak","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randy S","family":"Bell","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,5]]},"reference":[{"issue":"7","key":"bib1-20231011","first-page":"383","article-title":"The changing face of heroin use in the united states: a retrospective analysis of the past 50 years","volume":"71","author":"Cicero","year":"2014","journal-title":"Pharmacotherapy"},{"issue":"10","key":"bib2-20231011","doi-asserted-by":"crossref","first-page":"265","DOI":"10.15585\/mmwr.mm6610a1","article-title":"Characteristics of initial prescription episodes and likelihood of long-term opioid use united states, 2006\u20132015","volume":"66","author":"Shah","year":"2017","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"bib3-20231011","year":"2017"},{"issue":"5","key":"bib4-20231011","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1093\/pm\/pnx203","article-title":"Opioid therapy for chronic pain: overview of the 2017\u2009us department of veterans affairs and us department of defense clinical practice guideline","volume":"19","author":"Rosenberg","year":"2018","journal-title":"Pain Med"},{"key":"bib6-20231011","year":"2017"},{"key":"bib7-20231011","year":"2017","journal-title":"Opioid Overdose: U.S. Prescribing Rate Maps"},{"issue":"4","key":"bib8-20231011","doi-asserted-by":"crossref","first-page":"500","DOI":"10.2105\/AJPH.2017.304265","article-title":"Quantifying the epidemic of prescription opioid overdose deaths","volume":"108","author":"Seth","year":"2018","journal-title":"Am J Public Health"},{"issue":"2","key":"bib9-20231011","doi-asserted-by":"crossref","first-page":"e180217","DOI":"10.1001\/jamanetworkopen.2018.0217","article-title":"The burden of opioid-related mortality in the United States","volume":"1","author":"Gomes","year":"2018","journal-title":"JAMA Network Open"},{"issue":"6","key":"bib10-20231011","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1097\/MLR.0b013e31824ebd81","article-title":"Doctor and pharmacy shopping for controlled substances","volume":"50","author":"Peirce","year":"2012","journal-title":"Medical Care"},{"key":"bib11-20231011","doi-asserted-by":"crossref","first-page":"h2698","DOI":"10.1136\/bmj.h2698","article-title":"Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study","volume":"350","author":"Park","year":"2015","journal-title":"BMJ"},{"issue":"8","key":"bib12-20231011","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1007\/s11606-015-3199-4","article-title":"Drug overdose in a retrospective cohort with non-cancer pain treated with opioids, antidepressants, and\/or sedative-hypnotics: interactions with mental health disorders","volume":"30","author":"Turner","year":"2015","journal-title":"J Gen Intern Med"},{"issue":"10","key":"bib13-20231011","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1111\/pme.12236","article-title":"Benzodiazepines in long-term opioid therapy","volume":"14","author":"Reisfield","year":"2013","journal-title":"Pain Med"},{"issue":"2","key":"bib14-20231011","doi-asserted-by":"crossref","first-page":"155","DOI":"10.21037\/jss.2017.04.04","article-title":"Effects of immediate post-operative pain medication on length of hospital stay: does it make a difference","volume":"3","author":"Elsamadicy","year":"2017","journal-title":"J Spine Surg"},{"issue":"1","key":"bib15-20231011","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.ygyno.2018.08.015","article-title":"Celecoxib versus ketorolac following robotic hysterectomy for the management of postoperative pain: an open-label randomized control trial","volume":"151","author":"Ulm","year":"2018","journal-title":"Gynecol Oncol"},{"issue":"7","key":"bib16-20231011","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1001\/jamasurg.2017.0898","article-title":"Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: a review","volume":"152","author":"Wick","year":"2017","journal-title":"JAMA Surg"},{"issue":"3","key":"bib17-20231011","doi-asserted-by":"crossref","first-page":"329","DOI":"10.3122\/jabfm.2014.03.130290","article-title":"Risk of adverse health outcomes with increasing duration and regularity of opioid therapy","volume":"27","author":"Paulozzi","year":"2014","journal-title":"J Am Board Fam Med"},{"issue":"1","key":"bib18-20231011","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1370\/afm.1885","article-title":"Prescription opioid duration, dose, and increased risk of depression in 3 large patient populations","volume":"14","author":"Scherrer","year":"2016","journal-title":"Ann Fam Med"},{"issue":"2","key":"bib19-20231011","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1111\/jcpt.12121","article-title":"Duration of opiate exposure as a determinant of arterial stiffness and vascular age in male opiate dependence: a longitudinal study","volume":"39","author":"Reece","year":"2014","journal-title":"J Clin Pharm Ther"},{"key":"bib20-20231011"},{"issue":"3","key":"bib21-20231011","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/S0885-3924(02)00691-7","article-title":"Cost of opioid-related adverse drug events in surgical patients","volume":"25","author":"Oderda","year":"2003","journal-title":"J Pain Symptom Manag"},{"issue":"4","key":"bib22-20231011","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1002\/phar.1223","article-title":"Cost and quality implications of opioid-based postsurgical pain control using administrative claims data from a large health system: opioid-related adverse events and their impact on clinical and economic outcomes","volume":"33","author":"Kessler","year":"2013","journal-title":"Pharmacotherapy: J Human Pharmacol Drug Therapy"}],"container-title":["Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/neurosurgery\/article-pdf\/86\/5\/717\/33040168\/nyz232.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/10.1093\/neuros\/nyz232","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:50:45Z","timestamp":1786121445000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1093\/neuros\/nyz232"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,5]]},"references-count":21,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.1093\/neuros\/nyz232","relation":{},"ISSN":["0148-396X","1524-4040"],"issn-type":[{"value":"0148-396X","type":"print"},{"value":"1524-4040","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,7,5]]}}}