A retrospective study evaluating the trend of opioid prescribing in low back pain at a UK teaching hospital

Ben Hunter, MBChB, BSc (Hons); Shiva Tripathi, MBBS, FRCA, CCT

doi:10.5055/jom.2021.0681

Authors

Ben Hunter, MBChB, BSc (Hons) https://orcid.org/0000-0001-9686-6738
Shiva Tripathi, MBBS, FRCA, CCT https://orcid.org/0000-0002-9489-1910

DOI:

https://doi.org/10.5055/jom.2021.0681

Keywords:

low back pain, opioids, prescribing, chronic pain

Abstract

Introduction: Current data suggest that the chronic use of strong opioids in low back pain (LBP) is increasing. There is evidence for the use of opioids in the initial management of LBP, but the efficacy in the long term is unknown. This article intends to examine the use of opioids in patients with chronic LBP over a period of three doctor-led clinics.

Methods: Single-center retrospective cohort study following 200 patients through the pain clinic at a UK teaching hospital for more than two clinic visits, up to a maximum of three. Data concerning demographics, pain scores, medication changes, and clinic outcome.

Results: Data collected showed that there was a significant correlation between baseline morphine equivalent amount (MEA) and final clinic MEA; initial pain scores and final clinic MEA; cause of LBP and final clinic LBP; and traumatic LBP and absolute change in MEA. There was no association between number of physical interventions and MEA. The sample also showed an average absolute change in MEA by 2.93 ± 57.86 mg. The proportion of patients with a MEA of >50 mg/d increased from 24 to 29 percent. The proportion of patients on opioids at least one opioid increased by 10 percent.

Conclusions: Significant predictors of final clinic MEA were initial pain scores, baseline MEA, and the cause of LBP. Duration of pain was a poor predictor of MEA. There was no association between MEA and number of interventions. In this cohort, the trend seems to be increasing the number and dose of opioids in patients with LBP.

Author Biographies

Ben Hunter, MBChB, BSc (Hons)

Christchurch Hospital, New Zealand

Shiva Tripathi, MBBS, FRCA, CCT

Royal Preston Hospital, United Kingdom

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