Factors Associated With Early Opioid Prescription Among Workers With Low Back Injuries

Stover, Bert D.; Turner, Judith A.; Franklin, Gary; Gluck, Jeremy V.; Fulton-Kehoe, Deborah; Sheppard, Lianne; Wickizer, Thomas M.; Kaufman, Joel; Egan, Kathleen

doi:10.1016/j.jpain.2006.03.004

« Previous Next »The Journal of Pain
Volume 7, Issue 10 , Pages 718-725, October 2006

Factors Associated With Early Opioid Prescription Among Workers With Low Back Injuries

Bert D. Stover
- Department of Environmental & Occupational Health Sciences, University of Washington School of Public Health and Community Medicine, Seattle, Washington
- Address reprint requests to Bert D. Stover, Environmental & Occupational Health Sciences, University of Washington, 1914 N. 34^th Street, Suite 101, Seattle WA 98103, USA. Tel.: +1 206 685-7080; fax: +1 206 685-7031.
Judith A. Turner
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington
Gary Franklin
- Department of Environmental & Occupational Health Sciences, University of Washington School of Public Health and Community Medicine, Seattle, Washington
- Washington State Department of Labor and Industries, Olympia, Washington
Jeremy V. Gluck
- Department of Environmental & Occupational Health Sciences, University of Washington School of Public Health and Community Medicine, Seattle, Washington
Deborah Fulton-Kehoe
- Department of Environmental & Occupational Health Sciences, University of Washington School of Public Health and Community Medicine, Seattle, Washington
Lianne Sheppard
- Department of Environmental & Occupational Health Sciences, University of Washington School of Public Health and Community Medicine, Seattle, Washington
- Department of Health Services, University of Washington School of Public Health and Community Medicine, Seattle, Washington
Thomas M. Wickizer
- Department of Biostatistics, University of Washington School of Public Health and Community Medicine, Seattle, Washington
Joel Kaufman
- Department of Environmental & Occupational Health Sciences, University of Washington School of Public Health and Community Medicine, Seattle, Washington
- Department of Epidemiology, University of Washington School of Public Health and Community Medicine, Seattle, Washington
Kathleen Egan
- Department of Environmental & Occupational Health Sciences, University of Washington School of Public Health and Community Medicine, Seattle, Washington

Received 22 December 2005; received in revised form 8 March 2006; accepted 15 March 2006. published online 09 May 2006.

Abstract

Prescription of opioids for nonmalignant musculoskeletal pain has increased substantially in recent years, but there is little information on the incidence of, or factors associated with, such prescription for work-related back pain. In a prospective cohort study (N = 1067), we examined associations between worker sociodemographic and other characteristics and opioid prescription within six weeks of the first medical visit for workers’ compensation claims for work loss due to back injury. We examined administrative, pharmacy, and worker-reported data. In bivariate logistic regression models, Hispanics were less likely than non-Hispanic whites to receive opioid prescriptions, and very high body mass index, daily tobacco use, greater pain and physical disability, pain radiating below the knee, injury severity categorizations (from medical records) of major sprain and radiculopathy, and worse mental health were associated with opioid prescription. Adjusting for demographics, pain intensity, and physical disability, opiate prescription was significantly associated with daily tobacco use, pain radiating below the knee, and injury severity categories (major sprain and radiculopathy). Knowledge of worker characteristics associated with early opioid prescription may be useful in future studies of the role of early pain treatment in influencing subsequent course of pain and disability among workers with back injuries.

Perspective

Little is known about patient characteristics that may influence physicians’ decisions concerning prescription of opioids for acute back pain. Not surprisingly, workers with more severe back injuries are more likely to be prescribed opioids, but reasons for prescription disparities based on ethnicity and tobacco use warrant further study.

Key words: Narcotics , opioid, workers’ compensation , back injuries , back pain