Pain severity and opioid use in patients with spine-related diagnoses

Clinical guidelines recommend opioid use only in severe and unresponsive cases of low back pain. Limited evidence exists on pain levels and opioid use in spine-related diagnoses (SRD). This study assessed the association between self-reported pain severity and opioid use among U.S. adults with SRD.

We conducted a retrospective cross-sectional analysis using 2018-2021 Medical Expenditure Panel Survey (MEPS) data. Adults aged ≥18 with SRD diagnoses and pain prescriptions were included. Pain severity was assessed using the Veterans Rand-12 item on pain interference with routine work. Pain medication use was determined from prescription records. Multivariable logistic regression was used to evaluate the association after controlling for other factors.

According to the MEPS, there were 1.91 million (95% CI: 1.71-2.11) adults with SRD receiving pain medications annually, among whom 63.92% received opioid prescriptions. Most of the SRD patients were <66 years (69.71%), females (63.14%), and non-Hispanic whites (76.25%). Over half reported high pain interference with their routine activities (52.06%) Multivariable logistic regression analysis revealed that SRD patients who reported high pain interference with their routine work had higher odds of opioid use compared to those who reported low pain interference with their routine work (OR = 2.92, 95%CI: 1.49-5.70).

Over half of SRD patients receiving pain medications reported high pain severity levels, and these high pain levels were associated with higher odds of opioid use. While this evidence aligns with the clinical recommendations, more research is needed to understand the opioid use in SRD.