Back Pain Outcomes Remain Poor for Pain Medication Users Older Than 55 Years

Back pain outcomes are worse for patients older than 55 years who use pain medication than those who cease medication use or who do not use it, according to the results of a study published in the European Journal of Pain.

Investigators from the University Medical Center in the Netherlands sourced data regarding back pain outcomes from the prospective, observational Back Complaints in the Elders (BACE) study. In this analysis, patients (N=666; aged >55 years) who presented between 2009 and 2011 with a new episode of back pain were evaluated for pain intensity and disability outcomes at 3 months on the basis of analgesic use.

The researchers divided participants into 2 groups. The first group included 483 patients who used pain medication (mean age, 66.6±7.8 years; 60.9% women) and 183 non-users (mean age, 66.3±7.4 years; 54.1% women). The users and non-users had median symptom durations of 30.0 (IQR, 20.0-90.0) and 60.0 (IQR, 21.0-150.0) days.

The research team monitored back pain outcomes using the numeric rating scale (NRS) scores. NRS scores for severity of back pain of last week for medication users and non-users were  5.5±2.7 and 4.3±2.4 points, respectively.

Among the pain medication group, most used nonsteroidal anti-inflammatory drugs (NSAIDs; n=249), followed by paracetamol (n=136), opioids (n=84), and other medications (n=14).

At baseline and 3 months, the pain medication users had an NRS pain intensity score of 6.0 and 4.9 points, and non-users had NRS scores of 4.7 and 2.7 points, respectively. The Roland-Morris Disability Questionnaire (RMDQ) was also used to evaluate back pain outcomes. Scores for the RMDQ were 11.8 and 10.8 points among pain medication users and 8.5 and 5.9 points among non-users at baseline and follow-up, respectively.

After accounting for confounders, back pain outcome intensity (β, 1.3; 95% CI, 0.9-1.8) and RMDQ (β, 2.3; 95% CI, 1.4-3.2) scores were higher among the pain medication users compared with non-users.

Stratified by medication use patterns, those who were persistent users (n=211) reported higher NRS scores at 3 months (mean, 5.0 points) compared with stoppers (n=232; mean, 2.4 points), non-users (mean, 3.3 points), and starters (n=31; mean, 4.3 points). Similarly, persistent users had higher RMDQ scores at 3 months (mean, 11.1 points) compared with stoppers (mean, 5.8 points), non-users (mean, 6.0 points), or starters (mean, 8.9 points).

Overall, stoppers had significantly lower NRS (β, -1.3; 95% CI, -1.8 to -0.7) and RMDQ (β, -1.6; 95% CI, -2.7 to -0.5) scores compared with non-users, indicating less severe back pain outcomes.

Stratified by medication type, compared with non-users, NRS was reported to be higher among opioid (β, 2.0; 95% CI, 1.0-2.7), NSAID (β, 1.4; 95% CI, 0.8-2.0), and paracetamol (β, 1.3; 95% CI, 0.7-2.0) users. Similarly, higher RMDQ scores were reported by opioid (β, 3.1; 95% CI, 1.4-4.8), NSAID (β, 2.4; 95% CI, 1.0-3.5), and paracetamol (β, 2.2; 95% CI, 0.8-3.5) users compared with non-users.

The major limitation of this study was that it was of an observational design and not a randomized trial.

“[M]edication use is frequent in older patients with back pain, and these patients have a higher intensity of pain and worse disability. At 3-month follow-up, patients in all subgroups, irrespective of persistence or type of medication, improved over time. Patients who deescalated or stopped pain medication improved the most,” the study authors report.