The course of opioid prescribing for a new episode of disabling low back pain: Opioid features and dose escalation.
Summary of "The course of opioid prescribing for a new episode of disabling low back pain: Opioid features and dose escalation."
Despite utilization concerns, little information is available on opioid prescribing for acute, disabling low back pain (LBP) and how opioid features (purity, strength, and length of action) and dose change over time. This information is important in targeting guideline implementation efforts and identifying risks for inappropriate prescribing. Using 2002-2003 United States' workers compensation claims, a cohort of 2868 cases with a new episode of work-related LBP and at least one opioid prescription was followed for 2years. Opioid prescriptions (timing, dose, and formulation), demographics, and medical data were captured. A longitudinal model of change was used to evaluate factors associated with dosing changes. Opioid prescribing typically began early in the course of care (median=8days, Inter-Quartile Range (IQR)=3, 43days) and was often prolonged (median=46days, IQR=14, 329). At the end of the observation period, 7.1% of non-surgical cases and 30.6% of surgical cases were still receiving opioids. The number of days between the initial LBP report and the first opioid prescription had the greatest association with subsequent dose escalation. Dose escalation was greater with pure formulations, and was not related to clinical severity or surgery. In contrast to previous and current guideline recommendations, opioid prescribing for acute LBP was often prolonged, and longer for surgical cases. These results reinforce recommendations to limit opioid duration, and suggest that consideration of opioid features, purity as an important one, can be part of a strategy to prevent escalating dosages.
Affiliation
Liberty Mutual Research Institute for Safety, University of Massachusetts Lowell, USA.
Journal Details
This article was published in the following journal.
Name: Pain
ISSN: 1872-6623
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20705393
- DOI: http://dx.doi.org/10.1016/j.pain.2010.04.012
Medical and Biotech [MESH] Definitions
Methadone
A synthetic opioid that is used as the hydrochloride. It is an opioid analgesic that is primarily a mu-opioid agonist. It has actions and uses similar to those of MORPHINE. It also has a depressant action on the cough center and may be given to control intractable cough associated with terminal lung cancer. Methadone is also used as part of the treatment of dependence on opioid drugs, although prolonged use of methadone itself may result in dependence. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1082-3)
Nalbuphine
A narcotic used as a pain medication. It appears to be an agonist at kappa opioid receptors and an antagonist or partial agonist at mu opioid receptors.
Receptors, Opioid, Kappa
A class of opioid receptors recognized by its pharmacological profile. Kappa opioid receptors bind dynorphins with a higher affinity than endorphins which are themselves preferred to enkephalins.
Receptors, Opioid, Mu
A class of opioid receptors recognized by its pharmacological profile. Mu opioid receptors bind, in decreasing order of affinity, endorphins, dynorphins, met-enkephalin, and leu-enkephalin. They have also been shown to be molecular receptors for morphine.
Receptors, Opioid, Delta
A class of opioid receptors recognized by its pharmacological profile. Delta opioid receptors bind endorphins and enkephalins with approximately equal affinity and have less affinity for dynorphins.
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