Association between clusters of back and joint pain with opioid use in middle-aged community-based women: a prospective cohort study

Sultana Monira Hussain,Gita D Mishra,Donna Urquhart,Anita E Wluka,Wendy J Brown,Helena Teede,Flavia M Cicuttini,Yuanyuan Wang,Geeske Peeters

doi:10.1186/s12891-021-04741-4

Abstract

BackgroundTo determine the relationship between clusters of back pain and joint pain and prescription opioid dispensing.MethodsOf 11,221 middle-aged participants from the Australian Longitudinal Study of Women’s Health, clusters of back pain and joint pain from 2001 to 2013 were identified using group-based trajectory modelling. Prescription opioid dispensing from 2003 to 2015 was identified by linking the cohort to Pharmaceutical Benefit Scheme dispensing data. Multinomial logistic regression was used to examine the association between back pain and joint pain clusters and dispensing of prescription opioids. The proportion of opioids dispensed in the population attributable to back and join pain was calculated.ResultsOver 12 years, 68.5 and 72.0% women reported frequent or persistent back pain and joint pain, respectively. There were three clusters (‘none or infrequent’, ‘frequent’ and ‘persistent’) for both back pain and joint pain. Those in the persistent back pain cluster had a 6.33 (95%CI 4.38-9.16) times increased risk of having > 50 opioid prescriptions and those in persistent joint pain cluster had a 6.19 (95%CI 4.18-9.16) times increased risk of having > 50 opioid prescriptions. Frequent and persistent back and joint pain clusters together explained 41.7% (95%CI 34.9-47.8%) of prescription opioid dispensing. Women in the frequent and persistent back pain and joint pain clusters were less educated and reported more depression and physical inactivity.ConclusionBack pain and joint pain are major contributors to opioid prescription dispensing in community-based middle-aged women. Additional approaches to reduce opioid use, targeted at those with frequent and persistent back pain and joint pain, will be important in order to reduce the use of opioids and their consequent harm in this population.

Highlights

To determine the relationship between clusters of back pain and joint pain and prescription opioid dispensing
Chronic pain is complex with a multifactorial aetiology, often starting in early adulthood and with pain prevalence increasing with age [1]
Participants The Australian Longitudinal Study of Women’s Health (ALSWH) is a longitudinal survey of Australian women randomly selected from the Medicare database [30]

Summary

Introduction

To determine the relationship between clusters of back pain and joint pain and prescription opioid dispensing. Hussain et al BMC Musculoskelet Disord (2021) 22:863 a 31% prevalence of chronic pain (including back pain and joint pain) in people > 18 years old [2]. A recent systematic review which included 42 studies (28 from the USA, 9 from European countries, 3 from Canada and 1 each from Australia and India) reported that almost one-third of patients with chronic pain are prescribed opioids [5]. Long-term use of opioids worsens pain through the development of pain sensitization [6], and prolonged opioid use (defined as at least 1 opioid prescription within the first 90 days after hospital discharge, where the patient was introduced to opioid for the first time [7]) has been associated with high morbidity including opioid use disorders and mortality [8]. In developed countries, compassionate advocacy for better treatment of chronic pain influenced the liberalization of laws governing the opioid prescriptions, and along with aggressive marketing of opioid formulations, resulted in relying on opioids for chronic pain relief [5]

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