Early imaging for older patients with lower back pain linked to more pain, opioid use

  • Powell AC & al.
  • J Am Board Fam Med

  • von Kelli Whitlock Burton
  • Clinical Essentials
Der Zugang zum gesamten Inhalt dieser Seite ist nur Angehörigen medizinischer Fachkreise vorbehalten. Der Zugang zum gesamten Inhalt dieser Seite ist nur Angehörigen medizinischer Fachkreise vorbehalten.

Takeaway

  • Nearly half of older patients with new-onset lower back pain (LBP) received imaging, even when it was not indicated, which was associated with increased opioid use, steroid injections, spinal surgery, and persistent pain.

Why this matters

  • Although early imaging for new LBP in young patients is not recommended, some guidelines offer it as an option in older patients, which these findings suggest may lead to more pain and invasive procedures.

Study design

  • Retrospective analysis of patients with LBP (n=57,293; mean age, 71.2 years) identified from a claims database (2012-2016).
  • Funding: HealthHelp and Humana Inc; Max Institute of Healthcare Management.

Key results

  • 46.4% of the patients received early imaging (within 6 weeks of LBP onset).
  • The aORs for early imaging vs no imaging within 6 weeks of LBP onset in patients with a history of opioid use (90 days before imaging) were for:
    • short-term opioid use (aOR, 1.21; 95% CI, 1.15-1.28),
    • nonchronic opioid use (aOR, 1.78; 95% CI, 1.69-1.88),
    • chronic opioid use (aOR, 1.13; 95% CI, 1.07-1.18),
    • steroid injections (aOR, 2.55; 95% CI, 2.28-2.85),
    • spinal surgery (aOR, 3.40; 95% CI, 2.97-3.90), and
    • persistent LBP (aOR, 1.09; 95% CI, 1.05-1.14).

Limitations

  • Unmeasured confounders may have influenced the results.

Coauthored with Chitra Ravi, MPharm