Relationship between patient-reported chronic low back pain severity and medication resources

Characterization of chronic low back pain (CLBP) severity from a patient's perspective can provide a context within which management strategies may be determined and therapeutic outcomes evaluated.

The aim of our study was to evaluate the association between patient-rated CLBP severity and medication resources.

Data were drawn from the Adelphi CLPB Disease Specific Programmme, a cross-sectional study of patients undertaken between September and November 2009. Patients reported the severity of their CLBP by answering the statement "Please rate how your chronic lower back pain condition is today" with responses of "mild," "moderate," or "severe." Severity was evaluated relative to physician-reported use of medications for the relief of CLBP and patient-reported satisfaction with pain relief and medications.

Data from 170 physicians and 1363 patients (mean age 55 years; 52.3% female) were analyzed. CLBP severity was rated as mild, moderate, and severe by 28.3%, 52.8%, and 18.0% of patients, respectively. Physician-reported analgesia requirements increased with CLBP severity (P < 0.05). Opioids, nonsteroidal antiinflammatory drugs, and muscle relaxants were the most commonly prescribed medications for CLBP. Opioid prescriptions increased with increasing severity (P < 0.05), and nonsteroidal antiinflammatory drug prescriptions declined. Purchase of over-the-counter medications was similar across severity categories (23%-26% of patients), but the monthly amount spent on over-the-counter drugs was more than twice as high in patients with severe CLBP ($29.90) than in other severity categories. Patient and physician satisfaction with pain-related medication was inversely associated with CLBP severity; inadequate response was the primary reason for physician dissatisfaction. Factors limiting generalizability include potential differences between participants and those who refused to participate; potential misdiagnosis of CLBP in a proportion of patients; and an inability for cause-and-effect imputation due to the cross-sectional nature of the study.

The relationship between patient-reported CLBP severity and medication prescribing patterns suggests that this rapid assessment may be of value for informing decisions regarding treatment options. The data also suggest that despite greater use of medications at greater CLBP severity, current options remain less than optimal in providing analgesic efficacy.