Highlights
- •Opioids were the most common prescription pain medications among U.S. adults with chronic low back pain.
- •Opioids were typically used long-term, and combined with other central nervous system-active agents.
- •Low level of education was strongly associated with opioid use in a chronic low back pain population.
Abstract
Many classes of medications have been evaluated in chronic low back pain (cLBP), however
their utilization in the community remains unclear. We examined patterns of prescription
medication use among Americans with cLBP in a nationally representative, community-based
sample. The Back Pain Survey was administered to a representative sample of U.S. adults
aged 20 to 69 years (N = 5,103) during the 2009 to 2010 cycle of the National Health
and Nutrition Examination Survey. cLBP was defined as self-reported pain in the area
between the lower posterior margin of the ribcage and the horizontal gluteal fold
on most days for at least 3 months (N = 700). Home-based interviews with pill bottle
verification were used to capture commonly prescribed medications for chronic pain.
Among the sample of U.S. adults with cLBP aged 20 to 69 years, 36.9% took at least
1 prescription pain medication in the past 30 days; of them, 18.8% used opioids, 9.7%
nonsteroidal anti-inflammatory drugs, 8.5% muscle relaxants, and 6.9% gabapentin or
pregabalin. Nonpain antidepressants and hypnotics were used by 17.8% and 4.7%, respectively.
Opioids were used long-term in 76.9% of cases (median = 2 years) and were frequently
coadministered with antidepressants, benzodiazepines, or hypnotics. Ninety-four percent
of prescription opioids in the cLBP population were used by individuals with less
than a college education. Opioids were the most widely used prescription analgesic
class in community-based U.S. adults with cLBP and were often coadministered with
other central nervous system-active medications. Opioid use was highly prevalent among
less educated Americans with cLBP.
Perspective
Because prescription opioid use is an issue of national concern, we examined pain-related
prescription medication use in community-dwelling U.S. adults with cLBP. Opioids were
the most common prescription pain medication, typically used long-term, in combination
with other central nervous system-active agents, and disproportionately among individuals
with less than a college education.
Key words
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Article info
Publication history
Published online: April 17, 2018
Accepted:
April 4,
2018
Received in revised form:
March 21,
2018
Received:
July 26,
2017
Footnotes
Dr. Shmagel was funded by a National Institutes of Health T32 grant for this research, Award Number 5T32DK007784-15. Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR000114. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Ensrud is a VA employee. This material is the result of work supported with resources and the use of facilities at the Minneapolis VA. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.
The authors have no conflicts of interest to declare.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
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© 2018 by the American Pain Society
