Transcript Slide 1

Changes in Opioid Use Over One Year in
Patients with Chronic Low Back Pain
®
Alejandra Garza, Gerald Kizerian, PhD, Sandra Burge, PhD
The University of Texas Health Science Center at San Antonio
Introduction
The management of chronic pain by opioids is
problematic for physicians.[2] Doctors are hesitant to
prescribe opioids because they have toxic side effects,
they may not truly offer better pain relief, and the largest
fear against their use is that patients may divert them for
illegal use, or may become addicted to them. [2,4] The
fate of opioids is unique in each patient, which makes it
difficult for physicians to predict how each patient will
respond to opioid medications.
Researchers have studied the disparities in
prescribing opioid medications, and found that
physicians are more likely to prescribe opioids to Whites
than African-Americans because physicians tend to
have more trust in Whites. In addition, minorities have
difficulties obtaining opioids at pharmacies.[3]. However,
little is known about disparities in use - who is likely to
quit opioid use, or who is likely to sustain its use over
time? [3,5] Therefore, we plan to determine what type of
patients change their usage of opioids to maintain pain
control.
Results
Change in Opioid Use by
Employment and Disability
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Started
Quit
None
Not
Employed
Not
On
employed
Disabled Disability
Change in Opioid Use by Ethnicity/Race
Methods
Subjects. Student research assistants enrolled
258 adult patients with 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 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 used reports in
patients’ medical records at baseline and one-year
followup, then 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.
Continued
100%
90%
80%
70%
60%
50%
Continued
40%
Started
30%
Quit
20%
None
10%
0%
Hispanic
White
African-Amer
Change in Opioid Use by Health
Insurance
100%
90%
80%
Results
The study sample consisted of 28% males and
72% females with a mean age of 54 years and a 13
year standard deviation. The study sample also
consisted of 50% White, 28% Hispanics, and 19%
African American. The population in the study were
77% unemployed, 22% employed, 55% not on
disability, and 45% either on or applying for disability.
With respect to insurance coverage, 21% had private
insurance, 60% had government insurance, and 19%
had county plan insurance.
Employment and Disability: People who were
employed were significantly less likely to take opioids
at all, (p=.03) and those on disability were more likely
to continue opioids across both time periods. (p=.001)
Ethnicity: Hispanics were significantly less likely to
take opioids, Whites were most likely to start opioids,
and African Americans were most likely to continue
opioids over time. (p=.03)
Insurance: People with private insurance were
least likely to use opioids, while people with a “County
Plan” for health insurance were most likely to quit.
(p=.035)
We also examined differences between opioidchange groups with regard to pain severity, age,
gender, income, and education but found no significant
group differences.
Acknowledgements
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.
References
1. Chen, I. Journal of General Internal Medicine (2005):
593-58.
2. Eriksen, J. Pain 125 (2006): 172-79.
3. Green, CR. Pain Medicine 4.3 (2003): 277-94.
4. Sullivan, MD. Pain 149 (2010): 345-53.
5. Tamayo-Sarver, JH. Pain 93.12 (2003): 2067-073.
6. Wiebalck, A. Baillikre's Clinical Anesthesiology 12.1
(1998): 19-38.
70%
60%
Continued
Started
Quit
None
50%
40%
30%
20%
10%
0%
Private
Insurance
Govt
Insurance
County Plan
Conclusions
In conclusion, people who were Hispanic,
employed, or had private insurance were least likely to
use opioid medicines at either point in time. White
patients were most likely to start opioids, while African
Americans were most likely to continue opioids. While
previous studies found that physicians were more likely
to prescribe opioids to Whites than African-Americans,[3].
the findings in this study indicated that Whites and
African-Americans were equally likely to be using opioid
medicines for their pain (‘started’ + ‘continued’), while
Hispanics were least likely. The disabled and
unemployed population usually depend on government
insurance for healthcare coverage, and our findings
were similar for these two groups. We observed that
disabled people were most likely to be using opioids for
pain; this group also may also have the worst pain
severity and physical function.
Pain severity did not determine group membership in
this study. Studies have found that medications other
than opioids, such as NSAIDS, have proven to be
effective in treating chronic pain. [1]
This study showed wide variability in who started,
stopped, and continued opioid use for their chronic low
back pain. Some associations here raise questions
about health care disparities for pain treatments. County
plan patients are uninsured; are they most likely to quit
opioid use due to its expense? Do Hispanics use less
opioid medication because they have less access, or
because of cultural norms addressing interventions for
pain? Primary care physicians should be familiar with
the wide range of interventions for chronic low back
pain, and guide their patients toward accessible,
affordable, and appropriate care.