ABSTRACT
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.
ABSTRACT
INTRODUCTION: Low back pain is one of the most frequent causes of consultation of the General Practitioner (GP). The purpose of the present study is to analyze the therapeutic management of low back pain, in relation to pain intensity, in the primary care setting and to assess its impact on the patient's quality of life. METHODS: From the computerized medical records of 65 GPs, all working in the Salerno province (South of Italy), data concerning non-cancer subjects affected by low back or sciatica pain, over 18 years, who consulted the GP in the period between February 1, 2015 and January 31, 2016, were extracted. Pain intensity and quality of life were reported using the 0-10 numeric rating scale (NRS) and the EQ-5D instruments, respectively. RESULTS: A total of 2555 subjects were identified: 28.7% reported mild pain (NRS 0-3), 55.6% moderate pain (NRS 4-6) and 15.7% severe pain (NRS 7-10). Only 35% of patients received a prescription for pain therapy (24.5% in mild pain; 34.1% in moderate pain and 57.1% in severe pain); non-steroidal anti-inflammatory drugs in monotherapy were the most prescribed therapeutic category regardless of pain intensity (61.1% in mild pain, 65.1% in moderate pain and 57.6% in severe pain, p=0.099), followed by strong opioids (17.2%, 15.3% and 24.5%, p=0.011). Overall, mean value for EQ-5D utility was 0.44 (0.61 in mild pain, 0.47 in moderate pain, 0.22 in severe pain). CONCLUSIONS: The results of this study highlight that low back pain is a highly debilitating condition, probably still under-treated or inadequately treated by the GP.
