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Opioid use for chronic low back pain: A prospective, population-based study among injured workers in Washington State, 2002-2005.

Authors
Franklin-GM; Rahman-EA; Turner-JA; Daniell-WE; Fulton-Kehoe-D
Source
Clin J Pain 2009 Nov-Dec; 25(9):743-751
NIOSHTIC No.
20036319
Abstract
OBJECTIVES: To determine (1) the natural history of prescription opioid use, (2) the predictors of long-term opioid use, and (3) the association between opioid dose and pain and function in a large cohort of workers with recent back injuries. METHODS: Prospective cohort of workers with back injuries (N=1883) interviewed 18 days (median) and 1 year after claim submission. Detailed pharmacy data were obtained from computerized records of paid bills. RESULTS: Forty-two percent of workers (781/1843) received an opioid in the year after injury, most (694/781, 89%) at or shortly after the first medical visit for the injury. Of these, most (410/694, 59%) received opioids only within the first quarter after injury, whereas 16% (111/694) received opioids for 4 quarters. Among these long-term users, total morphine equivalent dose (MED) increased significantly (P<0.01) from the first (mean, 2364 mg; standard deviation, 4019 mg) to the fourth (mean, 3824 mg; standard deviation, 5998 mg) quarter. Improvement by at least 30% in pain and function measure scores occurred in only 26% (95% confidence interval 18%-36%) and 16% (95% confidence interval 10%-25%), respectively, of long-term users. Opioid doses increased substantially over time in all but those in whom function improved. After adjustment for baseline pain, function, and injury severity, the strongest predictor of longer term opioid prescription was total MED in the first quarter. Workers receiving at least 40 mg MED per day in the first quarter had 6-fold odds of receiving longer-term opioids. DISCUSSIONS: For the small group of workers with compensable back injuries who receive opioids longer-term (111/1843, 6%), opioid doses increase substantially and only a minority shows clinically important improvement in pain and function. The amount of prescribed opioid received early after injury strongly predicts long-term use. More research is needed to understand clinical decisions to continue or increase opioid therapy after back injury.
Keywords
Back-injuries; Drugs; Drug-therapy; Injuries; Pain-tolerance; Pharmaceuticals; Pharmacodynamics; Risk-analysis; Risk-factors; Skeletal-disorders; Skeletal-system-disorders; Statistical-analysis; Work-analysis; Work-capability; Worker-health; Worker-motivation; Workers; Work-performance; Workplace-studies; Author Keywords: chronic pain; cohort; back pain; opiates; population-based; prospective; workers' compensation
Contact
Gary M. Franklin, MD, MPH, Department of Environmental and Occupational Health Sciences, University of Washington, 1914 N. 34th Street, 101, Seattle, WA 98103
Publication Date
20091101
Document Type
Journal Article
Email Address
meddir@u.washington.edu
Funding Type
Grant
Fiscal Year
2010
NTIS Accession No.
NTIS Price
Identifying No.
Grant-Number-R01-OH-004069
Issue of Publication
9
ISSN
0749-8047
Source Name
The Clinical Journal of Pain
State
WA
Performing Organization
University of Washington
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