Prescription Of Opioids For Back Pain Needs Improvement

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Prescription Of Opioids For Back Pain Needs Improvement

15 Apr 2004

Physicians' prescriptions of opioid drugs for back pain are inconsistent,

found a Duke University Medical Center (USA) study, the largest and most

comprehensive of its kind.

The study found significant regional, social and economic disparities in the

use of the powerful painkillers. Specifically, the researchers found that

patients are more likely to take opioid drugs for their back pain if they

live in the South, hold public insurance, are less educated and have low

income. Moreover, the use of a powerful opioid drug, oxycodone, doubled from

1996 to 1999, found the researchers.

The study, published in the April 15, 2004, issue of the journal Spine,

constitutes the largest and most comprehensive look at the use of opioids

for the treatment of back pain, according to the researchers.

Because of the heated controversy in medical circles about whether the use

of opioids is an effective and safe long-term treatment strategy for back

pain, the researchers believe the patterns and trends in opioid use they

have uncovered could provide a rational scientific basis for future

investigation of safety and effectiveness of these drugs in the U.S.

" The wide variations in the use of opioids suggest that there is a definite

need to improve prescribing patterns for patients with back pain, " said Duke

lead researcher Xuemei Luo, Ph.D. " A better understanding of the underlying

reasons why the variations occurred and what constitute most optimal

prescribing should help in setting effective national policy related to

prescribing practice. "

Back pain is a major health-care issue, Luo said, with an estimated 15 to 20

percent of all Americans suffering from back pain at least once during a

one-year period. An earlier study (January 2004) by Luo showed that back

pain patients consume more than $90 billion annually in health-care

expenses, with approximately $26 billion of that amount directly

attributable to treating the back pain.

" Despite its widespread use for back pain, no study has examined at the

national level the patterns and trends of opioid use among individuals with

back pain, " Luo continued. " While opioids are the most potent analgesic

available, many physicians are reluctant to prescribe them because of their

serious side effects, the potential for addiction and the possibility of

drug tolerance.

" Just as importantly, no well-designed large-scale clinical trial has proven

the efficacy of opioids as a long-term treatment of back pain, " said Luo, a

member sof Duke's Center for Excellence in Surgical Outcomes.

To better understand the use of opioids, the Duke team mined the 1996 to

1999 data from the Medical Expenditure Panel Survey (MEPS). The MEPS is a

national survey conducted by the Agency of Healthcare Research and Quality

(AHRQ) and the National Center for Health Statistics. Between 23 and 27

million people reported back pain during each year of the four-year period.

For the purposes of their study, back pain was defined as pain experienced

in any portion of the back, whether it be caused by back disorders, disc

disorders or injuries to the back at some point during one year.

Overall, the use of opioids increased from 11.6 percent in 1996 to 12.6

percent by 1999.

In terms of regions, the South had the highest percentage of back pain

patients taking opioids, ranging from 14.2 percent to 16.4 percent during

the four-year period. Even after controlling for several other factors that

may impact opioid use, people in the South were still more likely to use

opioids than people in the Midwest.

Insurance status was also a factor associated with opioid use even after

controlling for some other patient characteristics, with patients covered by

public insurance receiving opioids at more than twice the rate than those

with private insurance or those who were uninsured.

" The variation in opioid use between the South and the Midwest raises the

possibility that there may be a lack of consensus in opioid use among

physicians and patients between the regions, " she continued.

Patients with less than a 12th grade education consistently used more

opioids, with rates ranging from 13.1 percent to 14.5 percent during the

four-year period. In contrast, the rates for those with a greater than 12th

grade education ranged from 7.6 percent to 10.8 percent. Patients in

low-income families were also more likely to get opioids as well, with a

range of 12.8 percent to 15.9 percent, compared to a range of 8.5 percent to

10.3 percent for high-income families.

" While this study's goal wasn't to identify underlying determinants of

opioid use, we suspected several reasons for these patterns, " Luo said.

" Lower income and less educated people may be more likely to be involved in

heavy physical occupations, which could lead to more back pain and a higher

demand for opioids. Whatever the reasons, these data highlight the need for

more thorough studies. "

Among individual opioids, Luo found that the use of oxycodone doubled over

the course of the four years studied. She suspected that the increase maybe

related to the introduction in 1996 of a controlled-release form of the

potent drug, as well as an aggressive marketing campaign by its

manufacturer.

The use of hydrocordone also increased, but at a much slower rate. The rate

of increase in this agent was very similar to the rate of decline in the use

of propoxyphene, a drug found to have unwanted side effects, leading Luo to

speculate that patients using propoxyphene may switch to hydrocordone.

Luo's research was supported by Duke's Center for Clinical Effectiveness,

part of the department of surgery. Other members of the Duke team were

Pietrobon, M.D., and Lloyd Hey, M.D.

contact sources :

Xuemei Luo , (919) 681-5277

luo00003@...