Objective: Refractory chronic low back pain (CLBP) often leads to treatment with long-term opioids. Our goal was to describe the pharmaco-toxicological profile of opioid-treated CLBP patients and identify potential areas for care optimization.
Design: Cross-sectional analysis.
Setting: Outpatient primary care.
Participants: CLBP patients prescribed,≥ 30 mg/d of morphine-equivalent dose (MED)for≥3 months.
Outcome Measures: Self-reported clinical, medication (verified) and substance use, and urine drug testing (UDT) data were collected.
Results: Participants (N = 35) were 51.8 ± 9.7 years old, 80 percent female with CLBP for 14.2 ± 10.1 years, treated with opioids for 7.9 ± 5.7 years, with severe disability (Oswestry Disability Index score: 66.7 ± 11.4), and average pain score of 5.6± 1.5(0-10 rating scale). Participants reported using tobacco (N= 14), alcohol (N = 9) and illicit drugs or unprescribed medications (N = 10). On average, participants took 13.4 ± 6.8 daily medications, including 4.7± 1.8 pain-modulating and 4.7 ± 2.0 sedating medications. Among prescribed opioids, 57.1 percent were long-acting and 91.4 percent were short-acting, with a total of 144.5 ±127.8 mg/d of MED. Sixteen participants were prescribed benzodiazepines and/or Zolpidem/zaleplon. Fifteen participants had UDT positive for illicit drugs or unprescribed medications; in addition, eight tested positive for alcohol and 19 for cotinine. Compared to those with negative UDTs, those with positive UDTs (N= 15) received lowerdaily "total" and "extended release" opioid doses, and were more likely to test positive for cotinine (p > 0.05).
Conclusions: Study findings corroborate existing evidence for high medication burden and high likelihood of substance misuse among opioid-treated CLBP patients. Further research is needed to help understand causality and ways to optimize care and clinical outcomes.
All Science Journal Classification (ASJC) codes
- Pharmacology (medical)
- Anesthesiology and Pain Medicine