In the JournalsPerspective

Low back, multiple site pain increases risk for chronic opioid use

While chronic opioid use among patients with musculoskeletal pain declined overall, the risk for chronic use was highest among those with low back and multiple anatomical site pain, according to findings published in Annals of Internal Medicine.

“Musculoskeletal pain is a common condition, and patients who have it may transition to chronic opioid use,” Jasmin Moshfegh, MA, MSc, research analyst at Stanford University School of Medicine, and colleagues wrote. “However, the risk and risk factors for chronic opioid use among patients with new musculoskeletal pain are not fully understood.”

Moshfegh and colleagues analyzed data from 2007 to 2015 from the IBM MarketScan database to determine the risk and risk factors for chronic opioid use among opioid-naive, cancer-free, privately insured patients aged 18 to 64 years recently diagnosed with nontrauma-related musculoskeletal pain in the knee, neck, low back or shoulder (n = 412,021; 51% men; average age, 45 years).

Opioid-naive was defined as having no opioid prescriptions filled in the year prior to diagnosis. Chronic opioid use was defined as filling 10 or more prescriptions or having at least 120 days’ supply of either hydrocodone, hydromorphone, methadone, morphine, oxymorphone and oxycodone between 91 and 365 days after musculoskeletal pain diagnosis.

While chronic opioid use among patients with musculoskeletal pain declined overall, the risk for chronic use was highest among those with low back and multiple anatomical site pain.
Source: Adobe Stock

The researchers included patients with pain severe enough to require a second outpatient or ED visit within 30 days of the diagnosis and excluded patients with conditions that may be mistaken for musculoskeletal low back pain, such as UTIs and osteoporosis.

The annual risk for chronic opioid use was highest for multiple site pain (1.5%), followed by low back (1.4%), neck (0.43%), shoulder (0.3%) and knee (0.3%). Overall, the risk for chronic opioid use was 0.31% (95% CI, 0.29-0.33).

Prominent risk factors for chronic opioid use were anatomical location, including low back and multiple sites, and opioid use within 90 days of diagnosis.

During the study period, there was a decrease in knee, low back and multiple-site pain.

“Our data suggest that risk for chronic opioid use among patients with musculoskeletal pain has decreased and point to some measures (such as avoiding opioid use soon after diagnosis) to further reduce this risk, particularly among those with the risk factors identified here (for example, low back and multiple-site pain),” Moshfegh and colleagues concluded. “Patients with these risk factors should be closely followed and may benefit from involvement of a nonpharmacologic provider, such as a physical therapist or chiropractor.” – by Alaina Tedesco

 

Disclosures: Moshfegh reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.

While chronic opioid use among patients with musculoskeletal pain declined overall, the risk for chronic use was highest among those with low back and multiple anatomical site pain, according to findings published in Annals of Internal Medicine.

“Musculoskeletal pain is a common condition, and patients who have it may transition to chronic opioid use,” Jasmin Moshfegh, MA, MSc, research analyst at Stanford University School of Medicine, and colleagues wrote. “However, the risk and risk factors for chronic opioid use among patients with new musculoskeletal pain are not fully understood.”

Moshfegh and colleagues analyzed data from 2007 to 2015 from the IBM MarketScan database to determine the risk and risk factors for chronic opioid use among opioid-naive, cancer-free, privately insured patients aged 18 to 64 years recently diagnosed with nontrauma-related musculoskeletal pain in the knee, neck, low back or shoulder (n = 412,021; 51% men; average age, 45 years).

Opioid-naive was defined as having no opioid prescriptions filled in the year prior to diagnosis. Chronic opioid use was defined as filling 10 or more prescriptions or having at least 120 days’ supply of either hydrocodone, hydromorphone, methadone, morphine, oxymorphone and oxycodone between 91 and 365 days after musculoskeletal pain diagnosis.

While chronic opioid use among patients with musculoskeletal pain declined overall, the risk for chronic use was highest among those with low back and multiple anatomical site pain.
Source: Adobe Stock

The researchers included patients with pain severe enough to require a second outpatient or ED visit within 30 days of the diagnosis and excluded patients with conditions that may be mistaken for musculoskeletal low back pain, such as UTIs and osteoporosis.

The annual risk for chronic opioid use was highest for multiple site pain (1.5%), followed by low back (1.4%), neck (0.43%), shoulder (0.3%) and knee (0.3%). Overall, the risk for chronic opioid use was 0.31% (95% CI, 0.29-0.33).

Prominent risk factors for chronic opioid use were anatomical location, including low back and multiple sites, and opioid use within 90 days of diagnosis.

During the study period, there was a decrease in knee, low back and multiple-site pain.

“Our data suggest that risk for chronic opioid use among patients with musculoskeletal pain has decreased and point to some measures (such as avoiding opioid use soon after diagnosis) to further reduce this risk, particularly among those with the risk factors identified here (for example, low back and multiple-site pain),” Moshfegh and colleagues concluded. “Patients with these risk factors should be closely followed and may benefit from involvement of a nonpharmacologic provider, such as a physical therapist or chiropractor.” – by Alaina Tedesco

 

Disclosures: Moshfegh reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.

    Perspective

    The topic of prescription opioid use and abuse has been increasingly in the national spotlight over the past several years, prompting renewed focus on research to better understand the risks and potential methods for mitigation. 

    The study by Moshfegh, et al is an important reminder for clinicians about how chronic prescription opioid use can begin. Often, it can be a seemingly benign prescription for a musculoskeletal pain issue that blossoms into repeated prescriptions and eventually chronic use.

    The authors found that among numerous investigated pain regions or sites, low back pain had the greatest risk for developing chronic opioid use in opioid naïve patients. Not surprisingly, patients with pain at multiple sites also had a high risk. 

    While the study did show that potentially some recent efforts have been successful — there was a decrease in chronic opioid use for some pain regions over the study period — it highlights the importance of avoiding opioids, and in particular, multiple prescriptions for non-traumatic musculoskeletal pain.

    • Brian C. Werner, MD
    • Sports Medicine and Shoulder Surgery
      Assistant Professor of Orthopedic Surgery
      University of Virginia Health System
      UVA Sports Medicine

    Disclosures: Werner reports no relevant financial disclosures.

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