Patients with low back pain or pain at multiple sites at highest risk for chronic opioid use

1. Risk factors for chronic opioid use were highest in patients that had multiple sites of pain or low back pain.

2. The authors observed that patients with shoulder, knee and neck pain had the lowest unadjusted risk for chronic opioid use.

Evidence Rating Level: 2 (Good)

Study Rundown: Patients with low back pain are at high risk of chronic opioid use. Recent efforts related to primary care physician prescribing guidelines have been implemented with the goal to decrease over prescribing of opioids for low back pain or pain at multiple anatomical sites. The authors of this study characterized the risk and risk factors for chronic opioid use among opioid-naive patients who have newly received a diagnosis of musculoskeletal pain in the knee, neck, low back or shoulder. They observed that the risk for chronic opioid pain was highest with multiple-site pain, especially with low back or other multiple locations. The study limitations included that the sample population only included patients with private insurance and therefore may not be reflective of the U.S. population at large. Further, the authors acknowledged that “opioid-naïve” patients might have encountered opioids in other facets not captured in this study.

Click to read the study, published today in Annals of Internal Medicine 

Relevant Reading: Personalized Medicine and Opioid Analgesic Prescribing for Chronic Pain: Opportunities and Challenges

In-Depth [retrospective cohort]: The authors of this brief report utilized the IBM MarketScan database to collect their information. This population has a slightly more female predominance compared to the general U.S. population. The authors utilized data from January 2007 to December 2015, identifying 518 195 adults that were privately insured, cancer free, and had not filled opioid prescriptions in the year prior to their diagnosis of a non-trauma related musculoskeletal pain. Specifically, the authors observed the highest annual unadjusted risk for chronic opioid use in low back (1.4%) and multiple sites (1.5%). Further, they observed that during the study period, knee pain, low back and multiple-site pain decreased (P < 0.001). The authors concluded that the overall risk for chronic opioid use across the sample was 0.31% (95% CI, 0.29% to 0.33%).

Image: PD 

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