Higher utilization of the pharmacologic and non-pharmacologic therapies in patients with chronic low back pain in a developing country than in the USA: Treatment of chronic low back pain

Abstract

Introduction: Pain is a highly subjective experience and different studies have shown that the perception of the pain intensity depends on multiple factors, such as: gender, race, age, eye or hair color, socio-economic status, education, as well as psychological status of the person, etc. Despite those determinants there is an discrepancy in pain treating approach between the USA and the European countries. Low back pain has become a major socio-economic problem in the USA, with 70-85% of people in the North America being affected throughout their lifes compared with the average prevalence of back pain In Western Europe as 15%. Overall, NSAIDs are the most commonly prescribed medication for low back pain worldwide, however with liberalization of the law in the USA within past 20 years, and with the promotion of opioids as highly effective and safe treatment, they are getting prescribed widely and readily for different chronic pain conditions including chronic low back pain. Low back pain has become a major socio-economic problem in the USA, and Western Europe. The purpose of this prospective study was to determine the utilization of pharmacological and non-pharmacological treatments for chronic low back pain in developing countries. Methods: After approval of the ethics committee Medical School University of Belgrade we enrolled 185 patients. Any patients who were > 18 years, diagnosed with chronic low back pain and did not have a history of malignancy are included in the study. All of them completed the study. Results: Patients were between 21 and 91 years old (average age 61.2 ± 14.7), 43.5% of them were males and 56.5% females. The pain duration for these patients ranged from 2 months up to 20 years. Average VAS pain scores in rest 4.7 ± 2.3 and in movement 5.2 ± 2.1. All of these patients exploited different types of non-pharmacological treatments for their painful condition. The average improvements after these treatments were: physical therapy (52.2 ± 4.9%), massage (50.8 ± 4.8%), chiropractic manipulation (69.1 ± 10.4%) and acupuncture treatment (50 ± 11.6%). All patients used NSAIDs, with the average duration of therapy 24.2 ± 11.9 months, and the average effectiveness 61.6 ± 2.8%. These patients used compounding topical creams for 7.5 ± 2.3 months on average with effectiveness of 41.1 ± 3.5%. None of the patients used opioids. Majority of them - 72.8% never missed any day of work while 8.6% missed 10-30 days, and only 4.3% missed more than 30 days of work even though 79.6% patients had an active type of job (walking, bending, heavy lifting, etc). Discussion: Administration of opioids, epidural steroid injection, facet joint block in the treatment of chronic low back pain became extremly frequent in the USA in the last 15 years. Multimodal therapy approach of back pain is the main characteristic of the treatment strategies in the USA. Opposite to the USA, European strategy concern non-invasive, non-pharmacologic and pharmacologic approaches. Conclusion: Results of this study showed higher utilization of pharmacologic and non-pharmacological therapies in patients with chronic low back pain prior to opioids and interventional procedures than in the USA.