Prescription Medication Use Among Community-Based U.S. Adults With Chronic Low Back Pain: A Cross-Sectional Population Based Study

  • Anna Shmagel
    Address reprint requests to Anna Shmagel, MD, Division of Rheumatic and Autoimmune Diseases at the University of Minnesota, Division of Rheumatic and Autoimmune Diseases, 420 Delaware Street SE, MMC 108, Minneapolis, MN 55455.
    Division of Rheumatic and Autoimmune Diseases, University of Minnesota, Minneapolis, Minnesota
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  • Linh Ngo
    Division of Rheumatic and Autoimmune Diseases, University of Minnesota, Minneapolis, Minnesota
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  • Kristine Ensrud
    Medicine and Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota

    Chronic Disease Outcomes Research, Minneapolis VA Center, Minneapolis, Minnesota
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  • Robert Foley
    Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, Minnesota
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      • 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.


      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.


      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.

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