Neurotensin in the extended amygdala maintains wakefulness in novel environments.

Anterior cervical discectomy and fusion (ACDF) is a common surgical treatment for degenerative cervical spine pathologies, which often provides significant relief of radiculopathy and neck pain. However, a considerable subset of patients experience persistent or recurrent symptoms after surgery, and a notable proportion continue to use analgesic medications long after the acute perioperative phase. Nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol, and gabapentinoids are supported by robust evidence and are widely used as part of multimodal pain management. In contrast, prolonged use of opioids is associated with several problems, including dependence, poorer clinical outcomes, and reduced return-to-work rates. Given the clinical and public health implications of prolonged medication use after ACDF, evaluating postoperative trajectories of opioid and neuropathic pain medication use is essential for assessing outcomes. Existing data in cervical spine surgery remain limited, as previous studies have relied on selected patient populations or smaller cohorts, and postoperative pain medication use has not been assessed in a nationwide setting. The aim of this study was to investigate repeated postoperative purchases of opioids and neuropathic pain medications after ACDF and to identify factors associated with continued postoperative use by using a nationwide spine surgery register linked with a nationwide prescription database.