Chronic Low Back Pain Associated With High Comorbidity Burden

Patients with chronic low back pain (CLBP) were found to have a greater number of comorbid conditions than individuals without CLBP, and the number of comorbidities had a positive relationship with opioid use. These findings — from a retrospective, cross-sectional study — were published in Pain Practice.

Data for this study were sourced from the Rush University Medical Center Epic clinical data warehouse. Patient records from 2010 to 2021 were reviewed, and patients with CLBP (n=9589) were age- and gender-matched with patients in the control group (n=9589). Trends in comorbidities and opioid outcomes were compared between groups.

The median age of patients in the CLBP and control cohorts was 57 years, 62.32% were women, and 54.20% were White. The average number of comorbidities among patients with CLBP was 3.5, and the average number among patients in the control group was 2.4.

Overall, the most common comorbidities were hypertension (42.27%), lipid metabolism disorders (33.81%), rheumatoid arthritis (29.48%), obesity (25.74%), and joint arthritis (23.22%). All examined comorbidity rates were higher among the CLBP cohort compared with the control cohort (all P <.0001).

Patients with CLBP were more likely than patients in the control group to present with 17 comorbidities, the most likely of which were joint arthritis (odds ratio [OR], 2.693; 95% CI, 2.5084-2.8912), rheumatoid arthritis (OR, 2.3427; 95% CI, 2.1969-2.4981), obesity (OR, 1.8203; 95% CI, 1.7041-1.9445), anxiety (OR, 1.7695; 95% CI, 1.6389-1.9106), and hypertension (OR, 1.4652; 95% CI, 1.3832-1.552).

The most common treatments provided were opioids, followed by nonsteroidal anti-inflammatory drugs, physical therapy, and muscle relaxants.

Opioids were prescribed to 56.37% of patients with CLBP and 36.12% of patients in the control group (P <.0001). Patients with CLBP were more likely to have 2 or more prescribed opioids (P <.0001) compared with controls, with nearly half of patients with CLBP using 2 or more.

In general, increasing comorbidity count was found to be positively associated with increasing opioid use among both cohorts (P <.0001). Of note, opioid use was more common prior to 2016.

This study was limited by its retrospective design.

These data indicate that patients with CLBP are more likely to present with comorbidities than their non-CLBP counterparts, and that the comorbidity burden was positively associated with treatments prescribed. The study authors state, “CLBP patients use more opioids in all opioid classes with close to 50% of the cohort found to be using 2 or more opioids simultaneously.”