Cost of opioid-treated chronic low back pain: Findings from a pilot randomized controlled trial of mindfulness meditation-based intervention

Abstract

Objective Opioid-treated chronic low back pain (CLBP) is debilitating, costly and often refractory to existing treatments. This secondary analysis aims to pilot-test the hypothesis that mindfulness meditation (MM) can reduce economic burden related to opioid-treated CLBP. Design 26-week unblinded pilot randomized controlled trial, comparing MM, adjunctive to usual-care, to usual care alone. Setting Outpatient Participants Thirty-five adults with opioid-treated CLBP (≥ 30 morphine-equivalent mg/day) for 3+ months enrolled; none withdrew. Intervention 8 weekly therapist-led MM sessions and at-home practice. Outcome Measures Costs related to self-reported healthcare utilization, medication use (direct costs), lost productivity (indirect costs), and total costs (direct+indirect costs) were calculated for 6-month pre- and post-enrollment periods and compared within and between the groups. Results Participants (21 MM; 14 control) were 20% men, age 51.8 ± 9.7 years, with severe disability, opioid dose of 148.3 ± 129.2 morphine-equivalent mg/day, and individual annual income of $18,291 ± $19,345. At baseline, total costs were estimated at $15,497 ± 13,677 (direct: $10,635 ± 9,897; indirect: $4,862 ± 7,298) per participant. Although MM group participants, compared to controls, reduced their pain severity ratings and pain sensitivity to heat-stimuli (p<0.05), no statistically significant within-group changes or between-group differences in direct and indirect costs were noted. Conclusions Adults with opioid-treated CLBP experience a high burden of disability despite the high costs of treatment. Although this pilot study did not show a statistically significant impact of MM on costs related to opioid-treated CLBP, MM can improve clinical outcomes and should be assessed in a larger trial with long-term follow-up.

10 kHz spinal cord stimulation: a retrospective analysis of real-world data from a community-based, interdisciplinary pain facility

“…It is well documented that chronic low back pain is costly to treat, 47 with recent data suggesting that expenditures may be even greater for those patients treated with opioids. 48 Accordingly, chronic low back pain has been noted as a source of frustration for third-party payers. 49 Despite a recent review’s conclusions that SCS results in “cost savings and efficient use of health care resources relative to current standards of care”, 50 insurers may remain hesitant to cover SCS implantation given the considerable initial costs associated with SCS treatment.…”

Experiences of adults with opioid-treated chronic low back pain during the COVID-19 pandemic: A cross-sectional survey study

“…In a time of pandemic crisis, with worsening health status, vulnerable populations such as those with opioid-treated CLBP should be able to maintain or increase access to healthcare services, but this did not happen. [29] Although it might be tempting to apply unified "labels" to this population (i.e. this at-risk population experienced pandemic-related harms), the latent class analysis demonstrated significant heterogeneity, and that those who were affected most across one domain were also negatively impacted across other domains.…”

“…In a time of pandemic crisis, with worsening health status, vulnerable populations such as those with opioid-treated CLBP should be able to maintain or increase access to healthcare services, but this did not happen. [ 29 ]…”

“…Self-reported outcome measures were collected at baseline (pre-intervention) and again at 3-, 6-, 9- and 12-months post-entry. The measures included: the average pain intensity (BPI [ 18 ] ), physical function (ODI; BPI’s pain interference [ 18 ] ), morphine-equivalent dose of prescribed opioids (Timeline Followback method [ 21 , 22 ] ), health-related quality of life (12-item Short Form Survey, SF-12, physical, and mental health components [ 23 ] ), negative affect (Hospital Anxiety Depression Scale, HADS [ 24 ] ), opioid misuse risk (Current Opioid Misuse Measure, Current Opioid Misuse Measure [ 25 ] ), pain catastrophizing (Pain Catastrophizing Scale [ 26 ] ), loneliness (3-item UCLA Loneliness Scale [ 27 ] ), feeling loved (Feeling Loved instrument [ 28 ] ), healthcare utilization and level of productivity (HealthCare Utilization and Productivity Scale [ 29 ] ), and baseline demographics.…”

Cost-effectiveness and Safety of Interspinous Process Decompression (Superion)

“…Therefore, long-term prescription of opioids should be minimized in patients with spinal stenosis. Depending on the type of opioid prescribed, medication costs can be substantial, with the average cost of opioids in chronic lower back pain being $2,508 USD per year for opioids alone and up to $30,994 USD when direct costs (medication and hospital costs) and indirect costs (productivity loss, e.g., missed work days) are considered [8]. A study by Ashaye et al [9] reported annual prescription costs between £3 and £4,844 for opioids used for chronic musculoskeletal pain, whereas Shah et al [10] reported an average annual cost of $8,982.28 USD for patients treated for chronic back pain with opioids.…”