Richard Deyo

Oregon Health & Science University | OHSU · Department of Family Medicine

Contexte : Il existe peu de recherches sur l’efficacité à long terme des injections péridurales de corticostéroïdes (IPC) chez les personnes âgées, malgré la prévalence élevée des douleurs au dos et au membre inférieur dans ce groupe d’âge. Nous avons testé les hypothèses selon lesquelles les adultes plus âgés recevant une IPC, comparés aux patient...

Because osteoporosis is under-recognized in patients with vertebral fractures, we evaluated characteristics associated with osteoporosis identification. Most patients with vertebral fractures did not receive evaluation or treatment for osteoporosis. Black, younger, and male participants were particularly unlikely to have had recognized osteoporosis...

Background: There is limited research on the long-term effectiveness of epidural steroid injections (ESI) in older adults despite the high prevalence of back and leg pain in this age group. We tested the hypotheses that older adults undergoing ESI, compared to patients not receiving ESI: 1) have worse pain, disability and quality of life ("outcome...

Study design: Population based health record linkage study. Objective: To determine trends in hospital admissions and surgery for lumbar spinal stenosis, as well as complications and resource use in Australia. Summary of background data: In the United States, rates of decompression surgery have declined, whereas those of fusion have increased....

Commentary on: Clark W, Bird P, Gonski P, et al . Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2016;388:1408–16. Percutaneous vertebroplasty was widely used in patients with symptomatic acute vertebral compression fractures until t...

Background Current literature describes the limits and pitfalls of using opioid pharmacotherapy for chronic pain and the importance of identifying alternatives. The objective of this study was to identify the practical issues patients and providers face when accessing alternatives to opioids, and how multiple parties view these issues. Methods Qua...

Background Propensity scores are typically applied in retrospective cohort studies. We describe the feasibility of matching on a propensity score derived from a retrospective cohort and subsequently applied in a prospective cohort study of patients with chronic musculoskeletal pain before the start of acupuncture or usual care treatment and enrollm...

Introduction: Far fewer opioids are prescribed in Japan than in the United States. Methods: We conducted an online physician survey assessing attitudes and perceptions that might influence prescribing. A Japanese version was distributed to members of the Japan Primary Care Association and an English version to members of the American Academy of...

Background: A 2007 American College of Physicians guideline addressed pharmacologic options for low back pain. New evidence and medications have now become available. Purpose: To review the current evidence on systemic pharmacologic therapies for acute or chronic nonradicular or radicular low back pain. Data sources: Ovid MEDLINE (January 2008...

Background: A 2007 American College of Physicians guideline addressed nonpharmacologic treatment options for low back pain. New evidence is now available. Purpose: To systematically review the current evidence on nonpharmacologic therapies for acute or chronic nonradicular or radicular low back pain. Data sources: Ovid MEDLINE (January 2008 th...

Objective: To describe associations between health care utilization measures and patient-reported outcomes (PROs). Method: Primary data were collected from patients ≥65 years with low back pain visits from 2011 to 2013. Six PROs of pain and functionality were collected 12 and 24 months after the index visits and total and spine-specific relative va...

Some previous research has examined pain-related variables on the basis of prescription opioid dose, but data from studies involving patient-reported outcomes have been limited. This study examined the relationships between prescription opioid dose and self-reported pain intensity, function, quality of life, and mental health. Participants were rec...

Objectives. Little is known about clinicians’ use of prescription drug monitoring program (PDMP) profiles in decision-making. The objective of this qualitative study was to understand how clinicians use, interpret, and integrate PDMP profiles with other information in making clinical decisions. Design. Qualitative interviews of clinician PDMP users...

Background Long-term efficacy of opioids for non-cancer pain is unproven, but risks argue for cautious prescribing. Few data suggest how long or how much opioid can be prescribed for opioid-naïve patients without inadvertently promoting long-term use. Objective To examine the association between initial opioid prescribing patterns and likelihood of...

Purpose: To develop a complete and consistent prescription drug monitoring program (PDMP) data set for use by drug safety researchers in evaluating patterns of high-risk use and potential abuse of scheduled drugs. Methods: Using publically available data references from the US Food and Drug Administration and the Centers for Disease Control and...

A 41-year-old man reports the sudden onset of low back and left leg pain. The symptoms began while he was doing yard work and pulling out large bushes. Since the onset of the pain 2 days ago, it has worsened, although he took a single dose of ibuprofen when the pain began. The patient has no clinically significant medical history, and the physical...

Objectives. Clinician communication with patients regarding worrisome findings in Prescription Drug Monitoring Programs (PDMPs) may influence patient responses and subsequent care. The authors studied the range of approaches clinicians report when communicating with patients in this situation and how practice policies and procedures may influence t...

Study design: Analysis of the State Inpatient Database of North Carolina, 2005-2012, and the Nationwide Inpatient Sample, including all inpatient lumbar fusion admissions from non-federal hospitals. Objective: To examine the influence of a major commercial policy change that restricted lumbar fusion for certain indications, and to forecast the p...

To describe acupuncture and chiropractic use among patients with chronic musculoskeletal pain (CMP) at a health maintenance organization, and explore issues of benefit design and electronic medical record (EMR) capture. Cross-sectional survey. Kaiser Permanente members meeting EMR diagnostic criteria for CMP were invited to participate. The survey...

Epidural corticosteroid injections are commonly used to treat back and leg pain associated with lumbar spinal stenosis. However, little is known about which patient characteristics may predict favorable responses. To identify patient characteristics associated with benefits from epidural injections of corticosteroid with lidocaine versus epidural i...

Prospective cohort study. To determine whether there are distinct trajectories of back pain and function among older adults, and to identify characteristics that distinguish among patients with substantially different prognoses. Although the differential diagnosis and course of low back pain among older adults may differ from middle-aged adults, th...

Inconsistent reporting of outcomes in clinical trials of patients with non-specific low back pain (NSLBP) hinders comparison of findings and the reliability of systematic reviews. A core outcome set (COS) can address this issue as it defines a minimum set of outcomes that should be reported in all clinical trials. In 1998, Deyo et al. recommended a...

In contrast to the recommendations for younger adults, many guidelines allow for older adults with back pain to undergo imaging without waiting 4 to 6 weeks. However, early imaging may precipitate interventions that do not improve outcomes. To compare function and pain at the 12-month follow-up visit among older adults who received early imaging wi...

Supporting evidence looks promising but far from complete Chronic back pain is a leading cause of disability that has a major impact on patients, doctors, healthcare systems, and workplaces.1 Despite growing use in some countries of spinal imaging, opioid analgesics, spinal injections, and spinal fusion surgery, disability from back pain has incre...

Increases in prescriptions of opioid medications for chronic pain have been accompanied by increases in opioid overdoses, abuse, and other harms and uncertainty about long-term effectiveness. To evaluate evidence on the effectiveness and harms of long-term (>3 months) opioid therapy for chronic pain in adults. MEDLINE, the Cochrane Central Register...

Back pain affects most adults, causes disability for some, and is a common reason for seeking healthcare. In the United States, opioid prescription for low back pain has increased, and opioids are now the most commonly prescribed drug class. More than half of regular opioid users report back pain. Rates of opioid prescribing in the US and Canada ar...

Low back pain (LBP) is one of the most disabling and costly disorders affecting modern society, and approximately 90% of patients are labelled as having non-specific LBP (NSLBP). Several interventions for patients with NSLBP have been assessed in clinical trials, but heterogeneous reporting of outcomes in these trials has hindered comparison of res...

Use of Bone Morphogenetic Protein (BMP) as an adjunct to spinal fusion surgery proliferated following Food and Drug Administration (FDA) approval in 2002. Major safety concerns emerged in 2008. To examine whether published concerns about the safety of BMP altered clinical practice. Analysis of the National Inpatient Sample from 2002 through 2012. A...

Degenerative changes are commonly found in spine imaging but often occur in pain-free individuals as well as those with back pain. We sought to estimate the prevalence, by age, of common degenerative spine conditions by performing a systematic review studying the prevalence of spine degeneration on imaging in asymptomatic individuals. We performed...

Objectives:: Prescription Drug Monitoring Programs (PDMPs) can help inform patient management, coordinate care, and identify drug safety risks, abuse, or diversion. However, many clinicians are not registered to use these systems, and use may be suboptimal. We sought to describe outreach efforts in one state (Oregon); quantify uptake of system use...

Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed non-specific and may be due to multiple biologic and behavioral etiologies. Researchers us...

Purpose To define radiological criteria and parameters as a minimum standard in a structured radiological report for patients with lumbar spinal stenosis (LSS) and to identify criteria and parameters for research purposes. Material and methods All available radiological criteria and parameters for LSS were identified using systematic literature...

#### Key points A woman aged 71 with smoking related lung disease and frequent use of corticosteroids presented to clinic with acute severe low back pain. The pain began yesterday after she moved furniture in her apartment, is centrally located in the upper lumbar region without radiation to the legs, and is worse with movement. On examination, sh...

Background: Epidural glucocorticoid injections are widely used to treat symptoms of lumbar spinal stenosis, a common cause of pain and disability in older adults. However, rigorous data are lacking regarding the effectiveness and safety of these injections. Methods: In a double-blind, multisite trial, we randomly assigned 400 patients who had lu...

Background: Outcomes after in-hospital CPR in older adults with chronic illness are unclear. Methods: We examined inpatient Medicare data from 1994 through 2005 to identify CPR recipients. We grouped beneficiaries aged ≥ 67 years by severity of six chronic diseases-COPD, congestive heart failure (CHF), chronic kidney disease (CKD), malignancy, d...

Background The self-reported health and functional status of persons with back pain in the United States have declined in recent years, despite greatly increased medical expenditures due to this problem. Although patient psychosocial factors such as pain-related beliefs, thoughts and coping behaviors have been demonstrated to affect how well patien...

Objectives Prescription drug monitoring programs (PDMPs) are now active in most states to assist clinicians in identifying potential controlled drug misuse, diversion, or excessive prescribing. Little is still known about the ways in which they are incorporated into workflow and clinical decision making, what barriers continue to exist, and how cli...

Prescription drug monitoring programs (PDMP) are relatively new but potentially useful tools to enhance prudent prescribing of controlled substances. However, little is known about the types of clinicians who make most use of PDMPs, how they are incorporated into workflow, or how clinicians and patients respond to the information. We therefore surv...

Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed non-specific and may be due to multiple biologic and behavioral etiologies. Researchers us...

Back pain represents a substantial burden globally, ranking first in a recent assessment among causes of years lived with disability. Though back pain is widely studied among working age adults, there are gaps with respect to basic descriptive epidemiology among seniors, especially in the United States. Our goal was to describe how pain, function a...

In Reply We appreciate the comments of Edidin and colleagues as they touch on key elements of our study,1 and their previous article2 provides insightful contrast to our own.We included the “preprocedure subgroup” analysis to illustrate that a substantial proportion of the augmented group (29%) had a markedly lower risk of complications compared wi...

Study Design. Retrospective analysis of Medicare claims linked to a multi-center clinical trial.Objective. The Spine Patient Outcomes Research Trial (SPORT) provided a unique opportunity to examine the validity of a claims-based algorithm for grouping patients by surgical indication. SPORT enrolled patients for lumbar disc herniation, spinal stenos...

Purpose: This trial was designed to evaluate the optimal dose of massage for individuals with chronic neck pain. Methods: We recruited 228 individuals with chronic nonspecific neck pain from an integrated health care system and the general population, and randomized them to 5 groups receiving various doses of massage (a 4-week course consisting...

Study Design. Retrospective analysis of Medicare claims linked to a multi-center clinical trial.Objective. The Spine Patient Outcomes Research Trial (SPORT) provided a unique opportunity to examine the validity of a claims-based algorithm for grouping patients by surgical indication. SPORT enrolled patients for lumbar disc herniation, spinal stenos...

PURPOSE To describe how pain, functional status and health related quality-of-life vary by demographic factors among seniors presenting to primary care providers with new episodes of low back pain. METHOD AND MATERIALS We enrolled patients ≥ 65 years old who presented to a primary care provider with a new episode of back pain. We recruited study p...

In response to increasing use of lumbar fusion for improving back pain, despite unclear efficacy, particularly among injured workers, some insurers have developed limited coverage policies. Washington State's workers' compensation (WC) program requires imaging confirmation of instability and limits initial fusions to a single level. In contrast, Ca...

Purpose: There is no universally accepted standard of care for lumbar spinal stenosis. Several studies suggest surgical care results in better outcomes than conservative care, but the type of surgery (decompression vs. fusion) remains controversial. Interspinous spacer devices (“spacers”) have emerged as a new initial treatment alternative. Our obj...

The clinical entity "discogenic back pain" remains controversial at fundamental levels, including its pathophysiology, diagnostic criteria, and optimal treatment. This is true despite availability of four randomized trials comparing the efficacy of surgical and nonsurgical treatments. One trial showed benefit for lumbar fusion compared with unstruc...

Importance: The symptomatic benefits of spinal augmentation (vertebroplasty or kyphoplasty) for the treatment of osteoporotic vertebral compression fractures are controversial. Recent population-based studies using medical billing claims have reported significant reductions in mortality with spinal augmentation compared with conservative therapy,...

There is a credibility gap in interventional pain medicine. Our evaluations of the interventions we perform differ significantly from those of our colleagues in other specialties. This has significant ramifications that affect our patients, training programs, and reimbursement schedules. A similar difference of perception exists for some procedures...

Kreiner DS, Shaffer WO, Baisden JL, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J 2013;13:734-43 (in this issue).

Study design: Secondary analysis of the prospectively collected Veterans Affairs National Surgical Quality Improvement Program database. Objective: Determine rates of major medical complications, wound complications, and mortality among patients undergoing surgery for lumbar stenosis and examine risk factors for these complications. Summary of...

This article has no abstract; the first 100 words appear below. Visual evidence is compelling. Unlike an abstract measure of plasma glucose or blood pressure, a herniated disk — or a picture of one, thanks to the wonders of modern imaging — can be seen by doctors and patients. Furthermore, conventional wisdom would have it that knowing imaging resu...

In response to increasing abuse of prescription drugs, forty-four states have implemented-and five more states will soon adopt-monitoring programs to track prescriptions of controlled medications. Although these programs were originally designed to help law enforcement officials and regulatory agencies spot possible illegal activity, health care pr...

Study design: Cross-sectional analysis of electronic medical and pharmacy records. Objective: To examine associations between use of medication for erectile dysfunction or testosterone replacement and use of opioid therapy, patient age, depression, and smoking status. Summary of background data: Males with chronic pain may experience erectile...

Objectives: Little is known about how opioid prescriptions for chronic pain are initiated. We sought to describe patterns of prescription opioid initiation, identify correlates of opioid initiation, and examine correlates of receipt of chronic opioid therapy (COT) among veterans with persistent noncancer pain. Methods: Using Veterans Affairs adm...

Study design: Retrospective cohort analysis of Medicare claims for 2006-2009. Objective: To examine whether interspinous distraction procedures are used selectively in patients with more advanced age or comorbidity, and whether they are associated with fewer complications, lower costs, and less revision surgery than laminectomy or fusion surgery...

Chronic pain affects at least 116 million adults in the USA and exacts a tremendous cost in suffering and lost productivity. While health systems offer specialized pain services, the primary care setting is where most patients seek and receive care for pain. Primary care-based treatment of chronic pain by interdisciplinary teams (including behavior...

PURPOSE To determine if early imaging in Medicare recipients with spinal stenosis is associated with increased risk of surgery. METHOD AND MATERIALS This is a retrospective cohort study using nationwide Medicare claims data from 2002-2006. A 20% sample from the Standard Analytical Files and the Medicare Provider Analysis and Review claims data wer...

PURPOSE To compare mortality and rates of major medical complications in patients with osteoporotic vertebral compression fractures treated with spinal augmentation versus conservative management. METHOD AND MATERIALS We performed a retrospective cohort analysis using Medicare Parts A and B claims from 2002-2006. We identified a total of 126,292 p...

PURPOSE To compare total medical costs during the year following an osteoporotic vertebral compression fracture (VCF) in patients treated with spinal augmentation versus conservative management. METHOD AND MATERIALS We performed a retrospective cohort analysis using Medicare Parts A and B claims from 2002-2006. We identified a total of 125,792 pat...

Background: Health care costs associated with use of complementary and alternative medicine (CAM) by patients with spine problems have not been studied in a national sample. Objectives: To estimate the total and spine-specific medical expenditures among CAM and non-CAM users with spine problems. Research design: Analysis of the 2002-2008 Medic...

Unlabelled: Factors associated with high-dose opioid therapy for noncancer pain are poorly understood. We documented the prevalence of high-dose opioid use as well as associated demographic, clinical, and health service utilization correlates among low back pain patients. Patients prescribed higher doses of opioids (≥100 mg/day morphine equivalent...

Objectives: Complementary and alternative medicine (CAM) providers are becoming more integrated into the United States health care system. Because patients self-select CAM use, risk adjustment is needed to make the groups more comparable when analyzing utilization. This study examined how the choice of risk adjustment method affects assessment of...

Use of lumbar spine imaging, particularly advanced imaging, continues to grow rapidly in the United States. Many lumbar spine imaging tests are obtained in patients who have no clinical symptoms or risk factors suggesting a serious underlying condition, yet evidence shows that this routine imaging is not associated with benefits, exposes patients t...

To identify factors that account for variation in complication rates across hospitals and surgeons performing lumbar spinal fusion surgery. Discharge registry including all nonfederal hospitals in Washington State from 2004 to 2007. We identified adults (n = 6,091) undergoing an initial inpatient lumbar fusion for degenerative conditions. We identi...

An initiative of the National Physicians Alliance, the project titled "Promoting Good Stewardship in Clinical Practice," developed a list of the top 5 activities in primary care for which changes in practice could lead to higher-quality care and better use of finite clinical resources. One of the top 5 recommendations was "Don't do imaging for low...

Back pain is one of the most important causes of functional limitation, disability, and utilization of health care resources for adults of all ages, but especially among older adults. Despite the high prevalence of back pain in this population, important questions remain unanswered regarding the comparative effectiveness of commonly used diagnostic...

Lumbar spinal stenosis is one of the most common causes of low back pain among older adults and can cause significant disability. Despite its prevalence, treatment of spinal stenosis symptoms remains controversial. Epidural steroid injections are used with increasing frequency as a less invasive, potentially safer, and more cost-effective treatment...

Repeat lumbar spine surgery is generally an undesirable outcome. Variation in repeat surgery rates may be because of patient characteristics, disease severity, or hospital- and surgeon-related factors. However, little is known about population-level variation in reoperation rates. To examine hospital- and surgeon-level variation in reoperation rate...

Chronic low back pain is a common problem lacking highly effective treatment options. Small trials suggest that yoga may have benefits for this condition. This trial was designed to determine whether yoga is more effective than conventional stretching exercises or a self-care book for primary care patients with chronic low back pain. A total of 228...

Low back disorders are extremely common and account for an important (and growing) proportion of medical expenditures.1 Their prevalence and impact have led to an expanding array of treatments, including spinal injections, implantable devices, and surgical procedures. Over the last 15 years, there has been a dramatic increase in the use of many of...

For carefully selected patients with lumbar stenosis, decompression surgery is more efficacious than nonoperative treatment. However, some patients undergo repeat surgery, often because of complications, the failure to achieve solid fusion following arthrodesis procedures, or persistent symptoms. We assessed the probability of repeat surgery follow...