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dc.contributor.authorCifuentes, Manuel
dc.contributor.authorWebster, Barbara
dc.contributor.authorGenevay, Stephane
dc.contributor.authorPransky, Glenn S.
dc.date2022-08-11T08:08:35.000
dc.date.accessioned2022-08-23T16:00:27Z
dc.date.available2022-08-23T16:00:27Z
dc.date.issued2010-10-01
dc.date.submitted2012-05-21
dc.identifier.citationPain. 2010 Oct;151(1):22-9. Epub 2010 Aug 11. <a href="http://dx.doi.org/10.1016/j.pain.2010.04.012">Link to article on publisher's site</a>
dc.identifier.issn0304-3959 (Linking)
dc.identifier.doi10.1016/j.pain.2010.04.012
dc.identifier.pmid20705393
dc.identifier.urihttp://hdl.handle.net/20.500.14038/30884
dc.description.abstractDespite utilization concerns, little information is available on opioid prescribing for acute, disabling low back pain (LBP) and how opioid features (purity, strength, and length of action) and dose change over time. This information is important in targeting guideline implementation efforts and identifying risks for inappropriate prescribing. Using 2002-2003 United States' workers compensation claims, a cohort of 2868 cases with a new episode of work-related LBP and at least one opioid prescription was followed for 2 years. Opioid prescriptions (timing, dose, and formulation), demographics, and medical data were captured. A longitudinal model of change was used to evaluate factors associated with dosing changes. Opioid prescribing typically began early in the course of care (median=8 days, Inter-Quartile Range (IQR)=3, 43 days) and was often prolonged (median=46 days, IQR=14, 329). At the end of the observation period, 7.1% of non-surgical cases and 30.6% of surgical cases were still receiving opioids. The number of days between the initial LBP report and the first opioid prescription had the greatest association with subsequent dose escalation. Dose escalation was greater with pure formulations, and was not related to clinical severity or surgery. In contrast to previous and current guideline recommendations, opioid prescribing for acute LBP was often prolonged, and longer for surgical cases. These results reinforce recommendations to limit opioid duration, and suggest that consideration of opioid features, purity as an important one, can be part of a strategy to prevent escalating dosages. Elsevier B.V. All rights reserved.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=20705393&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1016/j.pain.2010.04.012
dc.subjectAdult
dc.subjectAnalgesics, Opioid
dc.subject*Disability Evaluation
dc.subject*Disabled Persons
dc.subjectDrug Prescriptions
dc.subjectFemale
dc.subjectHumans
dc.subjectInappropriate Prescribing
dc.subjectLongitudinal Studies
dc.subjectLow Back Pain
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectRetrospective Studies
dc.subjectWorkers' Compensation
dc.subjectCommunity Health and Preventive Medicine
dc.subjectPreventive Medicine
dc.subjectPrimary Care
dc.titleThe course of opioid prescribing for a new episode of disabling low back pain: opioid features and dose escalation
dc.typeJournal Article
dc.source.journaltitlePain
dc.source.volume151
dc.source.issue1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/fmch_articles/210
dc.identifier.contextkey2879120
html.description.abstract<p>Despite utilization concerns, little information is available on opioid prescribing for acute, disabling low back pain (LBP) and how opioid features (purity, strength, and length of action) and dose change over time. This information is important in targeting guideline implementation efforts and identifying risks for inappropriate prescribing. Using 2002-2003 United States' workers compensation claims, a cohort of 2868 cases with a new episode of work-related LBP and at least one opioid prescription was followed for 2 years. Opioid prescriptions (timing, dose, and formulation), demographics, and medical data were captured. A longitudinal model of change was used to evaluate factors associated with dosing changes. Opioid prescribing typically began early in the course of care (median=8 days, Inter-Quartile Range (IQR)=3, 43 days) and was often prolonged (median=46 days, IQR=14, 329). At the end of the observation period, 7.1% of non-surgical cases and 30.6% of surgical cases were still receiving opioids. The number of days between the initial LBP report and the first opioid prescription had the greatest association with subsequent dose escalation. Dose escalation was greater with pure formulations, and was not related to clinical severity or surgery. In contrast to previous and current guideline recommendations, opioid prescribing for acute LBP was often prolonged, and longer for surgical cases. These results reinforce recommendations to limit opioid duration, and suggest that consideration of opioid features, purity as an important one, can be part of a strategy to prevent escalating dosages. Elsevier B.V. All rights reserved.</p>
dc.identifier.submissionpathfmch_articles/210
dc.contributor.departmentDepartment of Family Medicine and Community Health
dc.source.pages22-9


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