August 14th, 2015

Early Opioid Prescription for Back Pain Doesn’t Up Risk of Chronic Use

Early Opioid Prescription for Back Pain Doesn't Up Risk of Chronic Use

August 6, 2015

NEW YORK - Early opioid prescription does not seem to increase the risk of long-term use of the drugs in people with back injuries, according to a new retrospective study.

In fact, patients with back pain who received opioids within a month of being injured were less likely to be using the drugs for longer than three months, Sara Heins, a PhD student at Johns Hopkins Bloomberg School of Public Health in Baltimore, and her colleagues found.

"We can't really say why they are at lower risk," Heins told Reuters Health in a telephone interview. "Addressing pain quickly might actually stop patients from becoming chronic pain patients, but it's also possible that we're seeing some confounding."

Some guidelines recommend against prescribing opioids for patients with non-severe chronic musculoskeletal pain in the first six weeks after injury, Heins and her team note in their report, online July 1 in Injury Prevention.

To investigate whether early opioid prescription might be associated with increased risk of chronic opioid use, the researchers looked at more than 123,000 workers' compensation claims for people with back and shoulder injuries.

Patients with back injury who received an early opioid prescription were at 33% lower risk of chronic opioid use than those who were prescribed the drugs later.

But among patients with shoulder injury, early opioid use was associated with a 29% increased likelihood of chronic use of the drugs. Further analysis showed that the increased risk was limited to shoulder pain patients who did not have a clear diagnosis in the first month of being injured.

"Prescribing opioids before really understanding the reason for the patient's pain could be an indicator of low quality of care in general," Heins said. "If a patient comes in with a pain complaint and there's no clear cause, they probably should not receive opioids until a diagnosis can be made."

The new study calls into question guidelines that recommend against early opioid prescribing to reduce the risk of chronic use, Heins said.

"Based on our findings and based on the fact that there wasn't much evidence supporting that recommendation in the first place, the recommendations should be reconsidered," she said. "There are a lot of factors that go into a decision to prescribe a patient opioids, but I don't think that there's really evidence to support waiting a set number of weeks."

SOURCE: http://bit.ly/1IWXsMv

Inj Prev 2015.