Low back pain patients with opioid use disorder more likely to get more opioids
One-quarter of Medicare beneficiaries seeking care for acute low back pain received opioid prescriptions, according to 2016 to 2019 data. Patients with opioid use disorder received higher opioid doses and were more likely to be coprescribed gabapentin.
Medicare beneficiaries with acute low back pain and opioid use disorder (OUD) underused nonpharmacologic pain therapies and commonly received opioids at high doses and coprescribed with gabapentin, a study found.
To determine any potential association between a pre-existing OUD diagnosis and the treatment of acute low back pain, researchers conducted a retrospective cohort study using 2016 to 2019 data on Medicare fee-for-service beneficiaries with a new episode of low back pain.
The main independent variable was OUD diagnosis measured prior to the first back pain claim. Researchers assessed use of nonpharmacologic therapies, specifically physical therapy and/or chiropractic care, as well as prescription opioids within 30 days of the first visit for back pain. Among opioid recipients, researchers looked at opioid dose and at coprescription of gabapentin. Results were published June 3 by the Journal of General Internal Medicine.
There were 1,263,188 patients with acute low back pain in the study, of whom 3.0% had OUD. Overall, 432,156 (34.2%) beneficiaries in the overall sample received opioids, gabapentin, physical therapy, or chiropractic care at baseline, while 831,032 (65.8%) did not. The prevalence of OUD in these groups was 6.6% versus 1.1%, respectively. Most beneficiaries with baseline pain treatment had received one or more opioid prescriptions in the six months preceding an acute low back pain diagnosis: 88.6% of those with OUD and 93.4% of those without OUD.
Receipt of nonpharmacologic treatments was less prevalent among individuals with OUD than without (6.5% vs. 16.9%). Chiropractic care was used by 3.1% of individuals with OUD compared with 11.3% of those without, while physical therapy was used in 4.0% of those with OUD and 7.9% of those without.
One-quarter (25.9%) of the overall sample received opioid prescriptions. Receipt of opioids was significantly more prevalent (62.7% vs. 24.8%) and occurred at higher doses for individuals with OUD than without. Average daily doses were 79 morphine milligram equivalents (MME) versus 38 MME, respectively. Gabapentin was also more commonly prescribed to patients with OUD than those without (19.9% vs. 7.6%). Among recipients of opioids, 21.4% of beneficiaries with OUD also received gabapentin compared with 12.2% among those without.
"This study points to complexities in managing [acute low back pain] in the presence of OUD and highlights the need to address significant gaps in guidelines and recommendations for treating acute pain among individuals with OUD," the authors concluded. "The advancement of such guidelines/recommendations has the potential to reduce ambiguity and improve clinician self-efficacy in providing safe, effective, and equitable pain management to individuals with OUD."