Opioid Use in Chronic Low Back Pain: A Population Study

The most common prescription drug in US adults with chronic low back pain (LBP) are opioids, according to a population study based on the 2009 to 2010 National Health and Nutrition Examination Survey and published in the Journal of Pain. Opioids in this population were found to be used long-term and in combination with other central nervous system-acting agents.

Data from individuals with no back pain (n=4403) and with chronic LBP who reported pain between the lower posterior margin of the ribcage and the horizontal gluteal fold every day for ≥3 months (n=700) were examined. Data on commonly prescribed medications for chronic LBP were obtained through home-based interviews and pill bottle verification.

Up to 36.9% of study participants were found to have taken ≥1 prescription pain medication within the last 30 days. A greater percentage of individuals with vs without chronic LBP reported using opioids (18.8% vs 4.3%, respectively; adjusted odds ratio [aOR], 4.4; 95% CI, 3.44-5.62; P <.001), nonsteroidal anti-inflammatory drugs (NSAIDs) (9.7% vs 4.1%, respectively; aOR 2.84; 95% CI, 2.00-4.03; P <.001), muscle relaxants (8.5% vs 1.3%, respectively; aOR, 5.95; 95% CI, 3.91-9.04; P <.001), and hypnotics (4.7% vs 2.1%, respectively; aOR, 1.95; 95% CI, 1.20-3.16; P <.001).

The majority (76.9%) of individuals with chronic LBP taking opioids reported taking opioids for ≥1 year. Duration of prescription medication use was greater in participants with vs without chronic LBP for opioids (median number of days, 702 vs 119 days, respectively; P <.001), acetaminophen (690 vs 31 days, respectively; P <.001), NSAIDs (522 vs 91 days, respectively; P <.001), and muscle relaxants (682 vs 142 days, respectively; P =.007). Opioid medications were commonly taken with antidepressants, benzodiazepines, or hypnotics. In addition, the majority (94%) of participants with chronic LBP who used prescription opioids did not have a college education, and a greater percentage of women vs men with chronic LBP used nonsteroidal anti-inflammatory drugs and muscle relaxants (P =.01).

Limitations of the analysis include its reliance on self-reported data, as well as its inability to account for dosage and frequency of prescription medication use.

“[T]he patterns of analgesic use among US adults with [chronic] LBP highlight long-term, and likely excessive use of opioids, possible underutilization of other classes of analgesics, and demographic disparities in the use of different classes of analgesics,” concluded the study authors. “As clinical guidelines continue to emphasize opioid-related harms and advocate for cautious prescribing, evidence-based education for patients and providers and expanded access to non-opioid [chronic] LBP treatments are urgently needed,” they added.

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Reference

Shmagel A, Ngo L, Ensrud K, Foley R. Prescription medication use among community-based US adults with chronic low back pain: a cross-sectional population based study [published online April 17, 2018]. J Pain. doi: 10.1016/j.jpain.2018.04.004