Prescription Medication Use Among Community-Based U.S. Adults With Chronic Low Back Pain: A Cross-Sectional Population Based Study

Abstract

Many classes of medications have been evaluated in chronic low back pain (cLBP), however their utilization in the community remains unclear. We examined patterns of prescription medication use among Americans with cLBP in a nationally representative, community-based sample. The Back Pain Survey was administered to a representative sample of U.S. adults aged 20 to 69 years (N = 5,103) during the 2009 to 2010 cycle of the National Health and Nutrition Examination Survey. cLBP was defined as self-reported pain in the area between the lower posterior margin of the ribcage and the horizontal gluteal fold on most days for at least 3 months (N = 700). Home-based interviews with pill bottle verification were used to capture commonly prescribed medications for chronic pain. Among the sample of U.S. adults with cLBP aged 20 to 69 years, 36.9% took at least 1 prescription pain medication in the past 30 days; of them, 18.8% used opioids, 9.7% nonsteroidal anti-inflammatory drugs, 8.5% muscle relaxants, and 6.9% gabapentin or pregabalin. Nonpain antidepressants and hypnotics were used by 17.8% and 4.7%, respectively. Opioids were used long-term in 76.9% of cases (median = 2 years) and were frequently coadministered with antidepressants, benzodiazepines, or hypnotics. Ninety-four percent of prescription opioids in the cLBP population were used by individuals with less than a college education. Opioids were the most widely used prescription analgesic class in community-based U.S. adults with cLBP and were often coadministered with other central nervous system-active medications. Opioid use was highly prevalent among less educated Americans with cLBP.

Perspective: Because prescription opioid use is an issue of national concern, we examined pain-related prescription medication use in community-dwelling U.S. adults with cLBP. Opioids were the most common prescription pain medication, typically used long-term, in combination with other central nervous system-active agents, and disproportionately among individuals with less than a college education.

Keywords: Low back pain; analgesics; epidemiology; opioids.

Figure 1

Co-administration of pain medications, non-pain antidepressants, and hypnotics in US Adults with cLBP, % (SE%). cLBP – chronic low back pain. SE – standard error. NSAIDs – non-steroidal anti-inflammatory drugs. APAP – acetaminophen. M. relax muscle relaxants. GABA – gabapentinoids. Benzo benzodiazepines. SSRIs – selective serotonin reuptake inhibitors. Other antidepr. – other non-pain antidepressants. The Heat Map shows the most frequently co-administered medications in red, and the least frequently co-administered medications in green. All estimates are weighted to represent percent of the national population 20–69 years of age. Note that some subjects used more than two classes of medications at the same time.

Figure 2

Demographic distribution of pain medication use in US Adults with cLBP cLBP – chronic low back pain. NSAIDs – non-steroidal anti-inflammatory drugs. *Chi-square p-value <0.05. The bar charts illustrate the distribution of pain medication use in the cLBP population by age, gender, race, and education level. All estimates are weighted to represent percent of the national population 20–69 years of age. Opioids were most often used by adults in their 40s and 50s. Among races, African Americans were the most likely to use prescription opioids, followed by whites. Americans with cLBP who achieved a college degree or higher, were significantly less likely to use opioid analgesics and muscle relaxants, than less educated Americans. Women with cLBP used more NSAIDs and muscle relaxants than men.