Sustainable Treatment for Low Back Pain Key in Reducing Opioid, Opioid-Sedative Prescriptions
Older patients were more likely to receive opioid-sedative coprescriptions to treat low back pain.
Clinicians and health care systems together must provide sustainable, effective treatment for low back pain in older adults, according to research results published in Drugs & Aging.1
Older patients were more likely to receive opioid-sedative coprescriptions to treat low back pain. | Image credit: Yeti Studio - stock.adobe.com
Untreated low back pain can lead to chronic disease and disability, but pharmacologic management via opioids is associated with numerous risks. In a retrospective, observational study, researchers sought to evaluate current inequities in pain management across the intersections of age, race, ethnicity, and care system in a sample of military-connected patients aged 30 to 85 years of age, enrolled in TRICARE or the Veterans Health Administration (VHA), and receiving care at either the VHA, the Military Health System, or nonfederal civilian health care facilities. Primary study outcomes included the receipt of an opioid prescription and an opioid-sedative (muscle relaxants, benzodiazepines, barbiturates, and hypnotics) coprescription within 1 year of low back pain index diagnosis.
Overall, the study sample included 160,830 patients. Investigators found that age was negatively associated with receipt of an opioid-sedative coprescription (OR, 0.99), but not significantly associated with receipt of an opioid (OR, 1.00), while Asian and Pacific Islander, Black, and Latino patients were less likely than white patients to receive either type of prescription (OR, 0.31, 0.56, and 0.49, respectively). Patients receiving care in the purchased care system or at another location were more likely to receive opioids or an opioid-sedative coprescription (OR, 1.78 and 2.22, respectively) relative to patients receiving care via the VHA.
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Individuals with a documented psychiatric diagnosis were also more likely to receive opioids or opioid-sedatives (OR, 1.07 and 1.09, respectively), relative to those without.
Investigators identified several two- and three-way interactions. In a three-way interaction of age, race and ethnicity, and care system, the probability of an opioid prescription for Asian and Pacific Islanders, Black, and Latino individuals decreased as age increased. Patients identifying as another race or ethnicity who received health care in the military health service also experienced this interaction.
For Blac patients, opioid prescription probability remained relatively stable across all ages among those seeking care in purchased or other care systems, but increased in white patients. Probability of opioid-sedative coprescriptions decreased by age for Asian and Pacific Islanders and Latino patients in the Military Health Service, but increased in white patients.
Patients with a nerve-related index low back pain diagnosis “had a stronger relationship” with opioid-sedative coprescriptions for Black vs white patients, with estimated marginal means indicating that white patients “were more likely to receive an opioid-sedative coprescription compared with Latino patients” without a nerve-related index low back pain diagnosis.
Study limitations include the sample size and inclusion criteria, which may limit generalizability to populations not connected to military service, analyses being limited to receipt of opioid prescriptions and not inclusive of other additional aspects of low back pain care, and a lack of clarity around “the extent to which racially minoritized, older people with [low back pain] receiving care in the VHA and [military health service] inequitably experience poorer health outcomes and development of comorbid conditions, as documented in civilian samples.”
But despite these limitations, “our findings carry important implications for care management of [low back pain] in older adults,” the researchers wrote. “We underscore gaps in pain management care across the lifespan in the [military health system], the VHA, and those who receive care in TRICARE-affiliated health care facilities.”
“Undertreatment of chronic [low back pain] can lead to impaired quality of life and further contribute to health inequities in care receipt and pain experiences in older adults,” they concluded. “Our work highlights opportunities for interventions to improve outcomes for older adults living with [low back pain], which can improve their overall quality of life.”
READ MORE: Pain Management Resource Center
