Prescribing Patterns of Pain Medications in Unspecific Low Back Pain in Primary Care: A Retrospective Analysis

Abstract

Acute low back pain (LBP) is one of the most prevalent diseases worldwide. Since there is evidence of excessive prescriptions of analgesics, i.e., opioids, the aim of this study was to describe the use of pain medications in patients with LBP in the Swiss primary care setting. A retrospective, observational study was performed using medical prescriptions of 180 general practitioners (GP) during years 2009–2020. Patterns of pain medications (nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol, and opioids) as well as co-medications were analyzed in patients with a LBP diagnosis. Univariable and multivariable regression analyses assessed GP and patient characteristics associated with the prescription of pain medication. Patients included were 10,331 (mean age 51.7 years, 51.2% female); 6449 (62.4%) received at least one pain medication and of these 86% receive NSAIDs and 22% opioids. GP characteristics (i.e., self-employment status) and patient characteristics (male gender and number of consultations) were associated with significantly higher odds of receiving any pain medication in multivariable analysis. 3719 patients (36%) received co-medications. Proton-pump-inhibitors and muscle relaxants were the most commonly used co-medications. In conclusion, two-thirds of LBP patients were treated with pain medications. Prescribing patterns were conservative, with little use of strong opioids and co-medications.

Treatment Patterns in Patients with Diagnostic Imaging for Low Back Pain: A Retrospective Observational Study

“…5,[24][25][26] In our study 34% of all patients received an opioid. Comparing this percentage of opioid use to the sparse national comparative data, 20 we found that the percentage in our study was almost twice as high. In addition, we discovered higher percentages of strong opioid use, although…”

“…Furthermore, our prescribing patterns were similar to those reported in a recent study which analyzed pharmacological treatment patterns in LBP patients in the Swiss primary care setting but regardless of diagnostic spine imaging. 20 In accordance with the available national guidance, 19 Ibuprofen, diclofenac, and mefenamic acid were the most commonly used medications and accounted for nearly 90% of all NSAID prescriptions. Alternative NSAIDs such as COX-2 inhibitors were only marginally used.…”

“…However, the basic characteristics of our patients (age and gender) were similar to those reported in a previous study investigating LBP in the primary care setting in the German-speaking area of Switzerland. 20 Third, we were unaware of any pain medications purchased by patients over the counter (OTC) which were not reimbursed by GM. Back pain is a frequent reason for OTC purchase of pain medications.…”

“…tramadol, as a weak opioid, was still the most common opioid prescribed. Our data differed from the comparative data 20 because we included only LBP patients with a diagnostic imaging of the spine and not the whole population with acute LBP. The same issue is true for the international comparative data as opioid treatment rates reported from the USA are similar, but the population studied included all patients with LBP and not specifically patients with diagnostic imaging.…”

“…In addition to patient characteristics, provider factors and local routines may influence prescribing behavior. 20,24,31,32 Thus, further studies are needed to identify patient groups at risk, and provider characteristics associated with increased and perhaps unnecessary opioid prescriptions in the Swiss healthcare setting.…”