Differences in Characteristics and Downstream Drug Use Among Opioid‐Naïve and Prior Opioid Users with Low Back Pain

Abstract

Background Recent clinical practice guidelines have suggested conservative treatment approaches, including physical therapy, are indicated as first-line treatment for patients with low back pain (LBP); however, LBP continues to be managed with opioids, despite decreases in function, morbidity, and insignificant improvements in pain. Objective The primary purpose was to compare characteristics and downstream medication use between patients with LBP with prior opioid exposure vs. those who were opioid-naïve. The secondary purpose was to explore the role of prior opioid use by LBP disability. Methods Seven hundred and nine participants in a LBP self-management class were evaluated utilizing self-report data at baseline and longitudinal claims data from the Military Health System Data Repository. Participants were dichotomized into opioid-naïve and prior opioid use groups and then further divided into low and high disability groups based on Oswestry Disability Index (ODI) scores. Patient characteristics, comorbidities, and medication use were compared between groups. Results Prior opioid users had significantly higher baseline ODI and Fear Avoidance Beliefs Questionnaire physical activity subscale and work subscale scores as well as pre-index instances of mental health disorders, chronic pain, and insomnia than opioid-naïve individuals. Prior opioid users filled significantly more pain medication prescriptions in the year after the index date than did opioid-naïve individuals. Prior opioid users were significantly more likely to be taking opioids at 1 year after the index date, regardless of disability level. Conclusion In patients presenting with LBP, prior opioid exposure appears to be related to increased analgesic use (opioid and non-opioid) and longitudinal analgesic utilization at 1 year after the index date.

Associates of Insomnia in People with Chronic Spinal Pain: A Systematic Review and Meta-Analysis

“…The purpose of this systematic review and meta-analysis was to identify factors associated with the presence and development of insomnia in people with nonspecific CSP. A total of 13 studies were included, which together described 25 different potential associates of insomnia [11,12,[36][37][38][39][40][41][42][43][44][45][46]. It was possible to carry out a meta-analysis for nine factors.…”

“…Twelve out of thirteen included studies were cross-sectional studies [11,12,[36][37][38][39][40][41][42][43][44][45]. One included study was a cohort study [46].…”

“…Nine studies used a validated questionnaire to retrieve information regarding the presence of insomnia [11,12,36,39,40,42,[44][45][46]. Three other studies used a self-designed questionnaire [38,41,43] and one study made use of a health database [37]. A detailed overview of the characteristics of the included studies can be found in Table 1.…”

“…Each of the following factors were only discussed in one included article: income [36], medical consultation [36], hospitalization [36], self-rated health [36], prior opioid use [37], high C-reactive protein blood levels [38], pain duration [39], spine surgery history [39], shoulder/arm pain [39], neck mobility problems [39], myofascial pain [39], headache [39], use of sleep medication [14], pain catastrophizing [42], traumatic onset [43], healthcare use [44] and race [13]. A detailed overview of all included studies with the identified factors and their related ORs is presented in Table 3.…”

The Risk of Prior Opioid Exposure on Future Opioid Use and Comorbidities in Individuals With Non-Acute Musculoskeletal Knee Pain

“… 9 , 17 - 19 Work has also been done to identify rates and predictors of opioid use for many conditions including musculoskeletal pain in non-surgical primary care settings. 20 However, outside of low back pain, 21 we have not found any investigation into the predictive value of prior opioid use for future opioid use in non-surgical and non-cancer pain cohorts.…”