Transcript Slide 1

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Changes in Opioid Use for Chronic Low Back Pain:
One-Year Followup
Roy X. Luo, Tamara Armstrong, PsyD, Sandra K. Burge, PhD
The University of Texas Health Science Center at San Antonio
Introduction
Methods
Low back pain contributes a large proportion of
family physician’s practice, and represents a
significant economic burden to the health care
system; diagnosis and treatment cost $25 billion
annually in the US (1). While opioid use to treat acute
pain and cancer pain is widely accepted, the efficacy
of long term use to alleviate chronic noncancer pain
is still controversial. Some studies have shown that
long term opioid therapy can decrease pain severity
and duration, while increasing physical functioning
and health status. (2,3). Others provide evidence that
long term use can lead to opioid tolerance, and even
hyperalgesia. (4) However, little is known about the
influence of changes in opioid use on health and pain
outcomes in chronic patients. Therefore, we
conducted a longitudinal study enrolling patients
across Texas to track how changes in patients’ daily
opioid regimens correlated with changes in their pain,
physical function, health perception, depression, and
likelihood of seeking treatments for their pain.
Subjects. Students enrolled 258 adult patients with chronic
low back pain from 9 outpatient clinics across Texas, and
completed followup data collection one year later with 159
patients (62% followup rate). Patients were eligible if they
had low back pain for 3 months or longer, and were
excluded if they were pregnant or had a diagnosis of cancer.
Procedure and Measurement. Students gathered data from
patient surveys and medical records at enrollment and 1year followup. A 6-page patient survey addressed
demographic characteristics, pain duration, frequency and
severity, physical functioning and general health, anxiety,
depression, substance abuse, and risk for opioid misuse.
Patients reported pain severity using a 10-point scale. From
participants’ medical records, students gathered information
about causes of low back pain, treatments for pain
(including medications, procedures, and surgeries),
comorbidities, and Body Mass Index (BMI). To assess
changes in opioid use, students divided this sample into four
groups: (1) no opioid use at baseline or followup; (2) no use
at baseline, use at followup; (3) use at baseline, no use at
followup; (4) opioid use at baseline and followup.
Results
Figure 1. Comparing Mean Health Outcomes of Baseline to Year 1 Followup Data
8
p = .055
7
6
p = .002
5
4
p = .468
3
Baseline
Year 1 Followup
p = .054
2
p = .109
1
0
Low Back Pain
Physical Function
Role Function
Health Perception
Depression
Health outcomes improved during the first year of this study. Depression decreased significantly, while low back
pain and physical function both improved (data approaches significance).
Demographics: 72% of study participants
were female. The average age of participants
was 54 yrs. 28.6% were Hispanic, 52.6%
were Caucasian, and 18.8% were African
American.
Are changes in opioid use associated with
use of other treatments for pain? Patients
who have been continuously using opioids
during the first year of the study were most
likely to visit a pain clinic (p = 0.034).
Changes in opioid use were unrelated to other
treatments such as injections, physical
therapy, manipulation, and surgical
procedures.
Figure 2. Changes In Opioid Use Between Baseline
And Year 1 Followup
Never Used
40%
32%
Used at baseline, quit before
followup
Started using at followup
11% 17%
Used at both baseline and
followup
Figure 3. Changes In Opioid Use With Respect To Patient’s Duration Of Low Back Pain
Patients who had low back
pain for longer durations were
significantly more likely to
begin using opioids (p =
0.027).
However, changes in opioid
use had no significant
correlation with changes in
pain intensity, physical or role
function, general health, or
depression.
Conclusions
Acknowledgements
Summary of Findings – Mean health outcomes improved
in the first year of the study. We did not observe a significant
correlation between changes in opioid use and changes in
health outcomes. However, patients who had pain for longer
durations were significantly more likely to begin opioid use
during this year of the study. This may be due to increased
age, and a corresponding greater chance of comorbidities
that could increase pain and prompt opioid use in these
patients. Utilization of pain clinics also correlated with
continuous use of opioids.
This study was conducted in the Residency Research Network of
Texas (RRNeT) with support from the Dean’s Office, School of
Medicine, UTHSCSA; the Texas Academy of Family
Physicians; the South Texas Area Health Education Center; the
National Center for Research Resources (Award # UL
1RR025767); and the Health Resources and Services
Administration (Award # D54HP16444). The content is solely
the responsibility of the authors and does not necessarily
represent the official views of the National Center for Research
Resources of the National Institutes of Health.
Limitations – We accrued a 62% followup rate, so the data
presented here do not reflect the other 38% of patients that
we were unable to reach.
Implications – More research is needed to advise clinical
decisions on beginning or increasing opioid use. These
medication changes appeared to have no influence on pain,
health, functino, or depression. Our preliminary data raises
an interesting question for future inquiry: Do age related
factors influence patients’ decisions to begin opioid use?
References
1. Bratton R. Assessment and management of acute low back
pain. American Family Physician 1999; 60(8).
2. Dagtekin, O, et. Al. Assessing Cognitive and Psychomotor
Performance Under Long-Term Treatment with Transdermal
Buprenorphine in Chronic Noncancer Pain Patients.
Anasthesia&Analgesia. 2007; 105(5).
3. Jamison, RN, et al. Opioid Therapy for Chronic Noncancer
Back Pain: A Randomized Prospective Study. Spine 1998;
23(23).
4. Franklin, GM, et al. Opioid use for chronic low back pain.
Clin J Pain 2009; 25(743-751).