Trajectories of Prescription Opioid Use for Low Back Pain Patients

Understanding longitudinal trajectories of prescription opioid use, and associated risk factors, can inform clinical practice. However, little is known regarding trajectories of opioid use for patients with low back pain, a prevalent health condition in the United States.

The objective of this study was to identify opioid prescribing trajectories for patients with low back pain and describe the resulting trajectory classes.

We used group-based trajectory modeling of electronic health records from 2011 to 2018 to identify latent trajectory classes of prescribed opioids (milligram morphine equivalent or MME) before and after index visits for low back pain in six annual cohorts. We characterized class demographics, health status, and utilization histories.

Our sample included 74,181 index outpatient visits. Modeling identified four latent trajectory classes among patients with opioid prescriptions, in addition to a fifth zero-prescription class. Most visits were associated with no prescribed MME (65%-79% of visits, depending on the annual cohort) or low prescribed MME (18%-30%). Additionally, there were small but notable trajectory classes with persistent high (1%-2%), increasing (1%-5%), and decreasing (0%-1%) prescribed MME. Patients with persistent high prescribed opioid doses had a high prevalence of psychiatric diagnoses and benzodiazepine use, whereas patients with increasing opioid doses had varying characteristics depending on the annual cohort.

A small proportion of low back pain patients had concerning patterns of persistent high or increasing prescribed opioids. However, the overall number of patients with persistently high or increasing use may be large nationally due to the high prevalence of low back pain. Interventions may be warranted for patients with profiles like the persistent high use trajectory class. More research is needed to understand risk factors for the increasing use trajectory class.