Poster Presentation Sydney Spinal Symposium 2022

What proportion of patients with chronic low back pain are prescribed versus use an opioid medicine? Systematic review and meta-regression of observational studies. (#17)

Stephanie Mathieson 1 2 , Graeme Wertheimer 3 , Christopher Maher 1 2 , Christine Lin 1 2 , Andrew McLachlan 1 , Rachelle Buchbinder 4 5 , Sallie Pearson 6 , Martin Underwood 7 8
  1. The University of Sydney, Camperdown, NSW, Australia
  2. Institute for Musculoskeletal Health, Camperdown, NSW, Australia
  3. School of Medicine, University of Notre Dame, Darlinghurst, NSW, Australia
  4. Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Vic, Australia
  5. Department of Epidemiology and Preventive Medicine, Monash University, Malvern, Vic, Australia
  6. Medicines Policy Research Unit Centre for Big Data Research in Health, University of New South Wales, Kensington, NSW, Australia
  7. Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
  8. University Hospitals of Coventry and Warwickshire, University of Warwick, Coventry, UK

Background

Clinical guidelines now discourage the prescribing of opioid analgesics for chronic low back pain because the benefits frequently do not outweigh the harms.

 

Aims

To determine the extent that patients with chronic low back pain are prescribed an opioid analgesic compared to the self-reported consumption of opioid analgesics.

 

Methods

Electronic databases were searched without language restrictions. We included observational studies of adults with chronic low backpain measuring opioid prescribing and use. Opioids were categorised as weak (e.g. codeine) or strong (e.g. oxycodone). Study quality was assessed using a risk of bias tool designed for observational studies measuring prevalence. Individual study results were pooled using a random-effects model. Meta-regression investigated study-level factors associated with prescribing (e.g. sampling year, the geographic region as per World Health Organization). The overall evidence quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation criteria.

 

Results

Twelve studies reported data on opioid analgesic prescribing between 1991 to 2015 (758,248 participants), of which seven studies were at low risk of bias. The pooled estimate of the proportion of patients with chronic low back pain prescribed opioids was 41.5% (95%CI 28.9% to 55.4%; low-quality evidence). Meta-regression determined that opioid prescribing was associated with the year of sampling (more prescribing in recent years) (P = 0.001) but not geographic region (P = 0.503)) or setting (P = 0.228).

 

Eight studies reported data on the self-reported use of opioids between 1990 to 2017 (106,191 participants), of which six studies had a moderate risk of bias. The pooled estimate of the proportion of people with chronic low back pain that used opioid analgesics was 29.8% (95%CI 20.5% to 41.2%; moderate-quality evidence). Meta-regression determined that opioid use was not associated with sampling year or geographic region.

 

Conclusion

Based on available published studies, opioid prescribing for patients with chronic low pain increased over time, but opioid analgesic use in this population did not significantly increase over time.