Management of Nonsurgical Refractory Low Back Pain in the United States: A Retrospective Analysis

Abstract

Abstract INTRODUCTION Low back pain (LBP) is the leading cause of disability worldwide. Patients with persistent LBP despite multiple interventions and who are ineligible for spine surgery are considered to have nonsurgical refractory back pain (NSRBP). We investigated the utilization of medications and nonpharmacologic therapies in this population in the United States. METHODS The IBM MarketScan® Research databases were used to identify adult patients with LBP diagnoses (excluding instability and nonmechanical etiologies) and a negative history of failed back surgery syndrome or spine surgery within the study period (2009-2016). Patients must have had medications prescribed within 2 wk of diagnosis or nonpharmacologic therapies for >30 d within the 3 to 24 mo following LBP diagnoses. The frequency of utilization of these therapies was calculated at 0 to 6, 6 to 12, and 12 to 24 mo postdiagnosis. RESULTS Among 55 945 patients, 69.8% of patients used nonpharmacologic therapy in the first 6 mo, 66.0% over the next 6 to 12 mo, and 78.7% in the second year. At all time points, the most-utilized therapies were chiropractic therapy, physical therapy (PT), and epidural or facet joint steroid injections. In the first 6 mo, 42.1% of patients saw a chiropractor, and 43.5% of patients attended PT; 13.6% of patients underwent ≥1 steroid injection. Over the next 6 mo, 38.5% of patients visited a chiropractor, 37.2% used PT, and 12.6% received ≥1 steroid injection. During the second year, 45.3% saw a chiropractor, 45.1% engaged PT, and 16.6% had ≥1 steroid injection. On average, 49.1% of patients used prescription pain medications over the 2 yr, most commonly opioids (40.5%), muscle relaxants (21.5%), and anticonvulsants (17.8%). CONCLUSION The majority of NSRBP patients used nonpharmacologic therapy, and almost half used prescription medications throughout the 2 yr. The most-utilized therapies were chiropractic therapy, PT, opioids, muscle relaxants, and anticonvulsants. Over 40% of patients engaged chiropractors or PT or used opioids.