Analgesic Usage for Low Back Pain: Impact on Health Care Costs and Service Use

Abstract

Study Design. Cross-sectional analysis of analgesic use by patients with low back pain (LBP).Objectives. To describe patterns of analgesic use and their cost implications for the use of other care services among individuals with LBP enrolled in a health insurance plan during 2001. It was hypothesized that the use of analgesics would be most frequent among patients with LBP with neurologic findings.Summary of Background Data. National guidelines have recommended analgesics as the primary pharmacologic treatment of LBP. The choice of specific analgesics has major cost and service use implications.Methods. The University of Pittsburgh Health System includes 18 affiliated hospitals, more than 5000 physicians, and a commercial health plan with 255,958 members in 2001. This study uses the System Health Plan's insurance claims database to identify members who had services provided for one of 66 International Classification of Diseases, Version 9, Clinical Modification codes that identify mechanical LBP (n ϭ 17,148).Results. In 2001, 7631 (43.5%) members with claims for LBP services had no analgesic pharmacy claims. The other 9517 (55.5%) had analgesics claims costing a total of $1.4 million; 68% of claimants were prescribed an opioid and 58% nonselective nonsteroidal antiinflammatory drugs (NSAID). The costs of opioids, NSAID, and cyclooxygenase-2 selective NSAID for patients with LBP represented 48%, 24%, and 28%, respectively, of total health plan expenditures for all uses of these drugs, including cancer. Opioid use was associated with the high volume usage of LBP care services. Patients with LBP with and without neurologic involvement and those with acquired lumbar spine structural disorders had similar patterns of analgesic use: those with congenital structural disorders were less likely to use analgesics; and those with psychogenic pain and LBP related to orthopedic devices were more likely to use opioids.Conclusions. With this health plan, a high proportion of patients with LBP had claims for opioids during 2001. The use of opioids by patients with LBP represents a major cost for the health plan, and is associated with specific patient characteristics and their use of other LBP services. The total national expenditure for the care of low back pain (LBP) is estimated to range from $20 to $50 billion per year.1,2 Back pain is the second most common symptom reported by persons visiting their primary care physician 3 and the most frequent complaint of individuals seen by orthopedic surgeons, neurosurgeons, and occupational medicine physicians. 4 It is the leading cause of physical disability among adults, and approximately 2% of the population is disabled because of spinal problems and related pain in any given year. 2,5 LBP is classified by the anatomic structures affected along with the clinical symptomatology.6 -8 The most common origin of LBP is from the musculoligamentous structures. However, discogenic abnormalities and apophyseal joint osteoarthritis can also be pain generators. Pain is usually localized to t...

Opioids in chronic noncancer pain

“…By contrast, Eriksen et al demonstrated worse pain, higher healthcare utilization and lower activity levels in opioid-treated patients compared with a matched cohort of chronic pain patients not using opioids [30]. Other studies have also shown that instead of improving functional status, opioid use has been associated with increased disability, medical costs, subsequent surgery and continued or late opioid use [61][62][63][64].…”

Narcotic Drug Use Among Patients with Lower Back Pain in Employer Health Plans: A Retrospective Analysis of Risk Factors and Health Care Services

“…Diagnostic tests, such as radiography, computed tomography, and magnetic resonance imaging (MRI), may be ordered to assist in clinical decision-making. Although >18% of all patients with LBP use chiropractic services, 20 there is currently no clear recommendation for best practices. 18 Carey et a1 21 found that patients with LBP who received care from chiropractors were the most satisfied with perception of care, compared to patients who received care from orthopedic surgeons or primary care physicians.…”

“…Almost half (48%) of the money spent on opioids was for LBP, compared with only 21% for cancer pain in 2001 among 17,148 LBP patients. 20 Patients with LBP are prescribed narcotic drugs in the primary care setting. Approximately 12% of patients with LBP who had short-term pain for <2 months and had good 52-week prognoses were prescribed narcotic drugs by their primary care physicians.…”

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