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Clin J Pain. 2018 Jun;34(6):552-558. doi: 10.1097/AJP.0000000000000571.

Associations Between Early Care Decisions and the Risk for Long-term Opioid Use for Patients With Low Back Pain With a New Physician Consultation and Initiation of Opioid Therapy.

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Department of Physical Therapy & Athletic Training, College of Health, University of Utah, Salt Lake City, UT.
Department of Pharmacy, Kaiser Permanente Colorado, Denver, CO.
Department of Pharmaceutical Evaluation & Policy Division, College of Pharmacy,University of Arkansas for Medical Sciences, College of Pharmacy, Little Rock, AR.



The aim of this study was to identify associations between early care decisions and long-term opioid (LTO) use in opioid-naïve patients with a new physician consultation for low back pain (LBP) at which an opioid was prescribed.


A retrospective study of claims data was used to identify opioid-naïve LBP patients who were prescribed opioids at the index physician visit. Early care variables captured included additional nonopioid medications prescribed within 14 days and provider visits or diagnostic imaging within 30 days of the index visit. A multivariate logistic model was used to identify early care variables associated with the outcome of (LTO) use in the year following the index visit controlling for patient factors.


A total of 707 patients were included in this study. The mean age was 38.1 (±11.6), and 67.8% were female individuals and 76.9% were Medicaid beneficiaries. Early care medications were muscle relaxants (32.2%), nonsteroidal anti-inflammatories (29.3%), oral steroids (11.7%), and benzodiazepines (8.3%). The most common early care provider visits were with primary care (31.0%) and physical therapy (13.0%). A total of 172 patients (24.3%) progressed to LTO use. Controlling for patient factors, early care variables increasing risk for LTO use were an early benzodiazepine prescription and primary care visit. An early physical therapy visit was associated with reduced risk for LTO use.


Early care decisions were predictive of LTO use following a new LBP consultation at which opioids were prescribed. Our results support recommendations to avoid concurrent benzodiazepine prescribing and to consider other evidence-based pain treatments such as physical therapy early, particularly for patients at high risk for LTO use or misuse.

[Indexed for MEDLINE]

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