Medication use for low back pain in primary care

Daniel C. Cherkin, Kimberly J. Wheeler, William Barlow, Richard (Rick) Deyo

Research output: Contribution to journalArticle

129 Citations (Scopus)

Abstract

Study Design. A longitudinal observational study of primary care patients with low back pain. Objectives. 1) To describe medications prescribed for back pain, 2) to identify patient characteristics associated with type of drug the therapy, 3) to determine if the prescription of certain drugs is associated with better outcomes, and 4) to compare physician prescribing behavior with national guidelines. Summary of Background Data. Few previous studies have focused on medication prescribing patterns for back pain in primary care. Methods. Two-hundred nineteen patients aged 20 - 69 years who were making a first visit of an episode of back pain were studied. After the visit, patients completed questionnaires regarding sociodemographic characteristics, health status back pain experience, and uses of medications. Symptom severity and dysfunction were assessed by telephone 1 week after the visit. Results. Sixty-nine percent of patients were prescribed nonsteroidal anti-inflammatory drugs, 35% muscle relaxants, 12% narcotics and 4% acetaminophen. Twenty percent received no medications. Patients were more likely to receive medications if they had a desire for medication pain below the knee less than 3 weeks of pain before visit more severely symptoms, or greater dysfunction. Patients with more severe symptoms were more likely to receive narcotics or muscle relaxants. Patients with greater dysfunction were also more likely to receive narcotics. Type of drug therapy predicted symptom severity but not dysfunction after 1 week. Controlling for other factors, those receiving medications had less severe symptoms after 1 week than patients who received no medication. Patients receiving both muscle relaxants and nonsteroidal anti-inflammatory drugs had the best outcomes. Medications use for back pain in his health maintenance organization was generally concordant with national guidelines. Conclusions. Nonsteroidal anti- inflammatory drugs, often augmented by muscle relaxants, are a standard medical treatment for back pain in primary care in this observational study, patients prescribed medications, particularly muscle relaxants, reported less severe symptoms after 1 week than those receiving no medications. However, randomized trials are needed to determine which medications or combinations of medications are most effective.

Original languageEnglish (US)
Pages (from-to)607-614
Number of pages8
JournalSpine
Volume23
Issue number5
DOIs
StatePublished - Mar 1 1998
Externally publishedYes

Fingerprint

Low Back Pain
Primary Health Care
Back Pain
Narcotics
Muscles
Anti-Inflammatory Agents
Observational Studies
Pharmaceutical Preparations
Guidelines
Drug Therapy
Pain
Prescription Drugs
Health Maintenance Organizations
Acetaminophen
Telephone
Health Status
Longitudinal Studies
Knee
Physicians

Keywords

  • Back pain
  • Guidelines
  • Medications
  • Outcomes
  • Primary care

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Medication use for low back pain in primary care. / Cherkin, Daniel C.; Wheeler, Kimberly J.; Barlow, William; Deyo, Richard (Rick).

In: Spine, Vol. 23, No. 5, 01.03.1998, p. 607-614.

Research output: Contribution to journalArticle

Cherkin, DC, Wheeler, KJ, Barlow, W & Deyo, RR 1998, 'Medication use for low back pain in primary care', Spine, vol. 23, no. 5, pp. 607-614. https://doi.org/10.1097/00007632-199803010-00015
Cherkin, Daniel C. ; Wheeler, Kimberly J. ; Barlow, William ; Deyo, Richard (Rick). / Medication use for low back pain in primary care. In: Spine. 1998 ; Vol. 23, No. 5. pp. 607-614.
@article{e7b0d38bfac147ab81f86b4ff1a7c0d9,
title = "Medication use for low back pain in primary care",
abstract = "Study Design. A longitudinal observational study of primary care patients with low back pain. Objectives. 1) To describe medications prescribed for back pain, 2) to identify patient characteristics associated with type of drug the therapy, 3) to determine if the prescription of certain drugs is associated with better outcomes, and 4) to compare physician prescribing behavior with national guidelines. Summary of Background Data. Few previous studies have focused on medication prescribing patterns for back pain in primary care. Methods. Two-hundred nineteen patients aged 20 - 69 years who were making a first visit of an episode of back pain were studied. After the visit, patients completed questionnaires regarding sociodemographic characteristics, health status back pain experience, and uses of medications. Symptom severity and dysfunction were assessed by telephone 1 week after the visit. Results. Sixty-nine percent of patients were prescribed nonsteroidal anti-inflammatory drugs, 35{\%} muscle relaxants, 12{\%} narcotics and 4{\%} acetaminophen. Twenty percent received no medications. Patients were more likely to receive medications if they had a desire for medication pain below the knee less than 3 weeks of pain before visit more severely symptoms, or greater dysfunction. Patients with more severe symptoms were more likely to receive narcotics or muscle relaxants. Patients with greater dysfunction were also more likely to receive narcotics. Type of drug therapy predicted symptom severity but not dysfunction after 1 week. Controlling for other factors, those receiving medications had less severe symptoms after 1 week than patients who received no medication. Patients receiving both muscle relaxants and nonsteroidal anti-inflammatory drugs had the best outcomes. Medications use for back pain in his health maintenance organization was generally concordant with national guidelines. Conclusions. Nonsteroidal anti- inflammatory drugs, often augmented by muscle relaxants, are a standard medical treatment for back pain in primary care in this observational study, patients prescribed medications, particularly muscle relaxants, reported less severe symptoms after 1 week than those receiving no medications. However, randomized trials are needed to determine which medications or combinations of medications are most effective.",
keywords = "Back pain, Guidelines, Medications, Outcomes, Primary care",
author = "Cherkin, {Daniel C.} and Wheeler, {Kimberly J.} and William Barlow and Deyo, {Richard (Rick)}",
year = "1998",
month = "3",
day = "1",
doi = "10.1097/00007632-199803010-00015",
language = "English (US)",
volume = "23",
pages = "607--614",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Medication use for low back pain in primary care

AU - Cherkin, Daniel C.

AU - Wheeler, Kimberly J.

AU - Barlow, William

AU - Deyo, Richard (Rick)

PY - 1998/3/1

Y1 - 1998/3/1

N2 - Study Design. A longitudinal observational study of primary care patients with low back pain. Objectives. 1) To describe medications prescribed for back pain, 2) to identify patient characteristics associated with type of drug the therapy, 3) to determine if the prescription of certain drugs is associated with better outcomes, and 4) to compare physician prescribing behavior with national guidelines. Summary of Background Data. Few previous studies have focused on medication prescribing patterns for back pain in primary care. Methods. Two-hundred nineteen patients aged 20 - 69 years who were making a first visit of an episode of back pain were studied. After the visit, patients completed questionnaires regarding sociodemographic characteristics, health status back pain experience, and uses of medications. Symptom severity and dysfunction were assessed by telephone 1 week after the visit. Results. Sixty-nine percent of patients were prescribed nonsteroidal anti-inflammatory drugs, 35% muscle relaxants, 12% narcotics and 4% acetaminophen. Twenty percent received no medications. Patients were more likely to receive medications if they had a desire for medication pain below the knee less than 3 weeks of pain before visit more severely symptoms, or greater dysfunction. Patients with more severe symptoms were more likely to receive narcotics or muscle relaxants. Patients with greater dysfunction were also more likely to receive narcotics. Type of drug therapy predicted symptom severity but not dysfunction after 1 week. Controlling for other factors, those receiving medications had less severe symptoms after 1 week than patients who received no medication. Patients receiving both muscle relaxants and nonsteroidal anti-inflammatory drugs had the best outcomes. Medications use for back pain in his health maintenance organization was generally concordant with national guidelines. Conclusions. Nonsteroidal anti- inflammatory drugs, often augmented by muscle relaxants, are a standard medical treatment for back pain in primary care in this observational study, patients prescribed medications, particularly muscle relaxants, reported less severe symptoms after 1 week than those receiving no medications. However, randomized trials are needed to determine which medications or combinations of medications are most effective.

AB - Study Design. A longitudinal observational study of primary care patients with low back pain. Objectives. 1) To describe medications prescribed for back pain, 2) to identify patient characteristics associated with type of drug the therapy, 3) to determine if the prescription of certain drugs is associated with better outcomes, and 4) to compare physician prescribing behavior with national guidelines. Summary of Background Data. Few previous studies have focused on medication prescribing patterns for back pain in primary care. Methods. Two-hundred nineteen patients aged 20 - 69 years who were making a first visit of an episode of back pain were studied. After the visit, patients completed questionnaires regarding sociodemographic characteristics, health status back pain experience, and uses of medications. Symptom severity and dysfunction were assessed by telephone 1 week after the visit. Results. Sixty-nine percent of patients were prescribed nonsteroidal anti-inflammatory drugs, 35% muscle relaxants, 12% narcotics and 4% acetaminophen. Twenty percent received no medications. Patients were more likely to receive medications if they had a desire for medication pain below the knee less than 3 weeks of pain before visit more severely symptoms, or greater dysfunction. Patients with more severe symptoms were more likely to receive narcotics or muscle relaxants. Patients with greater dysfunction were also more likely to receive narcotics. Type of drug therapy predicted symptom severity but not dysfunction after 1 week. Controlling for other factors, those receiving medications had less severe symptoms after 1 week than patients who received no medication. Patients receiving both muscle relaxants and nonsteroidal anti-inflammatory drugs had the best outcomes. Medications use for back pain in his health maintenance organization was generally concordant with national guidelines. Conclusions. Nonsteroidal anti- inflammatory drugs, often augmented by muscle relaxants, are a standard medical treatment for back pain in primary care in this observational study, patients prescribed medications, particularly muscle relaxants, reported less severe symptoms after 1 week than those receiving no medications. However, randomized trials are needed to determine which medications or combinations of medications are most effective.

KW - Back pain

KW - Guidelines

KW - Medications

KW - Outcomes

KW - Primary care

UR - http://www.scopus.com/inward/record.url?scp=0032033433&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032033433&partnerID=8YFLogxK

U2 - 10.1097/00007632-199803010-00015

DO - 10.1097/00007632-199803010-00015

M3 - Article

C2 - 9530793

AN - SCOPUS:0032033433

VL - 23

SP - 607

EP - 614

JO - Spine

JF - Spine

SN - 0362-2436

IS - 5

ER -