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.
Highlights
Comparing the patients with a back syndrome with radiating and without radiating pain, we found a higher proportion of female patients in the group with radiating pain. (Table 1)
We identified both general practitioners (GP) and patient characteristics
In subgroup analysis for each pain medication class we found that, after correcting for other confounding factors, patient age > 50 years, at the time of diagnosis, was significantly associated with increased odds of prescribing nonsteroidal anti-inflammatory drugs (NSAIDs) (OR: 1.24, 95%confidence interval (CI): 1.13–1.36, p < 0.001), but decreased odds of prescribing opioids (OR: 0.66, 95%CI: 0.58–0.76, p < 0.001) or paracetamol (OR: 0.84, 95%CI: 0.75–0.93, p = 0.001)
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Low back pain (LBP) is one of the most prevalent diseases worldwide [1]. The lifetime prevalence of LBP in developed countries is up to 80% [2,3,4,5] and a systematic review calculated the incidence ranged between 0.024 and 7.0% [6]. In Switzerland 43% of the population report an episode of LBP within the last four weeks [4] and back pain ranked second in patient reported reasons for physician consultations [7]
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