Opioid Prescribing Patterns for Low Back Pain Among Commercially Insured Children

Spine ◽  
2020 ◽  
Vol 45 (21) ◽  
pp. E1365-E1366
Author(s):  
Tej D. Azad ◽  
Michael D. Harries ◽  
Anand Veeravagu ◽  
John K. Ratliff
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Prescribing Patterns ◽  
Low Back ◽  
Opioid Prescribing

scholarly journals Opioid Prescribing Patterns for Low Back Pain Among Commercially Insured Children

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Tej D Azad ◽  
Michael D Harries ◽  
Daniel Vail ◽  
Yi Jonathan Zhang ◽  
John K Ratliff
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Prescribing Patterns ◽  
Low Back ◽  
Age Group ◽  
Newly Diagnosed ◽  
Opioid Prescription ◽  
Opioid Prescribing

Abstract INTRODUCTION Low back pain (LBP) may affect up to 20% of the pediatric population. No specific guidelines exist regarding pharmacotherapy for acute LBP in the pediatric population. Given this observation and the lack of data available regarding pharmacotherapy for pediatric LBP, we sought to characterize patterns of opioid prescribing in the pediatric population. METHODS We used a national database to identify pediatric patients (age 5-17) with newly diagnosed with LBP between 2008 and 2015 who did not have a red flag diagnosis, had not received an opioid prescription in the 6 mo prior to diagnosis, and had 12-mo of continuous enrollment after diagnosis. We used logistic regression to model the association between sex, geographic region, categorical age, and our primary outcome, receipt of an opioid prescription in the year following diagnosis. RESULTS Our sample included 268 228 opioid-naïve pediatric patients diagnosed with LBP between 2008 and 2015. We observed that 47 631 (17.8%) patients received physical therapy, 29 903 (11.2%) patients received chiropractic manipulative therapy, 658 (0.25%) patients received epidural steroid injection, and 281 (0.10%) patients received surgery. A total of 35 274 (13.2%) pediatric LBP patients were prescribed opioids within 12 mo from their diagnosis. Opioid prescribing decreased in all age groups over the study period age group 5 to 9 decreased from 4.2% to 2.7%, age group 10 to 14 decreased from 10.3% to 7.7%, and age group 15 to 18 yr decreased from 20.9% to 17.1%. Female pediatric patients were more likely than male patients to receive an opioid prescription (OR, 1.12, P < .0001). Patients ages 10 to 14 (OR, 2.89, P < .0001) and 15 to 18 (OR, 6.98, P < .0001) were significantly more likely to be prescribed opioids compared to patients in the youngest age group. CONCLUSION To our knowledge, we report the first observational cohort study of opioids and LBP in the pediatric population. Our findings indicate that opioids are being used for newly diagnosed LBP and receipt of opioids are associated with patient demographic factors.

scholarly journals LO65: Assessing opioid-prescribing patterns for low back pain patients before and after the implementation of clinician performance indicators in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S31-S31
Author(s):  
F. Yang ◽  
J. Dreyer ◽  
K. Van Aarsen
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Performance Indicators ◽  
Descriptive Analysis ◽  
Extended Period ◽  
Prescribing Patterns ◽  
Low Back ◽  
Opioid Prescribing ◽  
Left Without Being Seen ◽  
Before And After

Introduction: Canada is in the midst of an opioid crisis. The number of apparent opioid-related deaths between January and March 2018 increased by 44% compared to the same period in 2016. The increasing use of prescription opioids and higher doses of opioids can lead to opioid addiction, toxicity and even death. Opioids are commonly prescribed for low back pain management in the ED, but the variability in opioid-prescribing patterns suggested an opportunity for improvement. Our centre implemented Clinician Performance Indicators (CPI) in 2015. CPIs were reported to each ED physician every 3 months and included the percentage of patients who were prescribed opioids. The intent was to raise awareness of opioid-prescribing patterns at our institution. Therefore, we evaluated opioid-prescribing patterns for patients with low back pain (LBP) before and after the CPI implementation. Methods: Data were obtained retrospectively for patients discharged from the ED from July 2015 to December 2018 with LBP-associated ICD 10 codes. We excluded admitted patients, those with specialist consultations, and patients who left without being seen. The primary outcome was opioid prescribing patterns for patients with LBP before and after CPI implementation. We performed a descriptive analysis of the data and compared the prescribing rates pre-implementation (July-Dec 2015) to post-implementation (July-Dec 2016) following a 6-month wash-out period. Moreover, we analyzed opioid-prescribing patterns over an extended period until December 2018. Results: After the exclusion criteria were applied, 8993 patients were included in the analysis. 53.5% were female and the mean (SD) age was 48.3 (19.78). During the three years of the study period, the percentage of LBP patients who received opioids showed a decreasing trend. Comparison of the pre and post CPI implementation periods showed a decrease in opioid prescriptions (42.0% vs 35.5%, 95%CI 2.9% to 10.2%). There was variation in opioids prescribed at our institution, the most common being hydromorphone (29.9%), followed by acetaminophen-oxycodone (24.2%) and acetaminophen-tramadol (20.0%). Conclusion: The implementation of CPIs positively impacted physicians' opioid-prescribing patterns for patients presenting with LBPs at our institution. Future studies are required to further improve the effectiveness of CPIs in influencing opioid-prescribing patterns.

scholarly journals Time of Day is Associated with Opioid Prescribing for Low Back Pain in Primary Care

2018 ◽  
Vol 33 (11) ◽  
pp. 1828-1830 ◽  
Author(s):  
Lindsey M. Philpot ◽  
Bushra A. Khokhar ◽  
Daniel L. Roellinger ◽  
Priya Ramar ◽  
Jon O. Ebbert
Keyword(s):  
Primary Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Time Of Day ◽  
Low Back ◽  
Opioid Prescribing

The course of opioid prescribing for a new episode of disabling low back pain: Opioid features and dose escalation

Pain ◽  
2010 ◽  
Vol 151 (1) ◽  
pp. 22-29 ◽  
Author(s):  
Manuel Cifuentes ◽  
Barbara Webster ◽  
Stephane Genevay ◽  
Glenn Pransky
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Dose Escalation ◽  
Low Back ◽  
Opioid Prescribing

scholarly journals Predictors of Opioid Prescribing for Non-Malignant Low Back Pain in an Italian Primary Care Setting

2021 ◽  
Vol 10 (16) ◽  
pp. 3699
Author(s):  
Simona Cammarota ◽  
Valeria Conti ◽  
Graziamaria Corbi ◽  
Luigi Di Gregorio ◽  
Pasquale Dolce ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Pain Intensity ◽  
Care Setting ◽  
Primary Care Setting ◽  
Low Back ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
First Pain

This study explores which patient characteristics could affect the likelihood of starting low back pain (LBP) treatment with opioid analgesics vs. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in an Italian primary care setting. Through the computerized medical records of 65 General Practitioners, non-malignant LBP subjects who received the first pain intensity measurement and an NSAID or opioid prescription, during 2015–2016, were identified. Patients with an opioid prescription 1-year before the first pain intensity measurement were excluded. A multivariable logistic regression model was used to determine predictive factors of opioid prescribing. Results were reported as Odds Ratios (ORs) with a 95% confidence interval (CI), with p < 0.05 indicating statistical significance. A total of 505 individuals with LBP were included: of those, 72.7% received an NSAID prescription and 27.3% an opioid one (64% of subjects started with strong opioid). Compared to patients receiving an NSAID, those with opioid prescriptions were younger, reported the highest pain intensity (moderate pain OR = 2.42; 95% CI 1.48–3.96 and severe pain OR = 2.01; 95% CI 1.04–3.88) and were more likely to have asthma (OR 3.95; 95% CI 1.99–7.84). Despite clinical guidelines, a large proportion of LBP patients started with strong opioid therapy. Asthma, younger age and pain intensity were predictors of opioid prescribing when compared to NSAIDs for LBP treatment.

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