A Study of Pharmacologic Therapy in Patients with Chronic Low Back Pain

Purpose: This study aimed to examine the effects of different pharmacologic therapies on patients with chronic low back pain, including nonsteroidal anti-inflammatory drugs(NSAIDs), opioids, antidepressants, muscle relaxants, antipsychotics, and anticonvulsants. Outcomes included low back pain intensity, back-related functioning, and quality of life. Methods: This was a cross-sectional study of patients within the PRECISION Pain Research Registry who met criteria for chronic low back pain established by the National Institutes of Health. Pharmacologic therapy was self-reported by patients. Back pain intensity was measured with an 11-point numerical rating scale (NRS). Back-related functioning was measured using the Roland-Morris Disability Questionnaire (RMDQ). Quality of life was measured using the SPADE cluster (sleep disturbance, pain interference with activities, anxiety, depression and low energy/fatigue) derived from the Patient-Reported Outcomes Measurement Information System (PROMIS-29). Higher scores represent worse health on all outcome measures. Results: Of 977 eligible patients, 323(33.1%) used opioids, 593(60.7%) used NSAIDs, 222(22.7%) used antidepressants, 160(16.4%) used muscle relaxants, 44(4.5%) used atypical antipsychotics, and 153(15.7%) used anticonvulsants. Mean NRS score for patients using opioids was 6.5 vs. 5.9 for non-users (p=0.13,95%CI(-0.925 - -0.390)). Mean RMDQ score for opioid users was 16.7 vs. 13.2 for non-users (p< 0.001,95%CI(-4.287 - -2.720)). Mean SPADE score for opioid users was 59.4 vs. 56.4 for non-users (p=0.15,95%CI(-3.910 - -1.9798)). Conclusion: Patients used a variety of pharmacologic therapies for chronic low back pain. Opioid users reported worse outcomes than non-users, including significant deficits in back-related functioning.