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The Use of Analgesic and Other Pain‐Relief Drugs to Manage Chronic Low Back Pain: Results from a National Survey
Author(s) -
Gouveia Nélia,
Rodrigues Ana,
Ramiro Sofia,
Eusébio Mónica,
Machado Pedro M.,
Canhão Helena,
Branco Jaime C.
Publication year - 2017
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/papr.12455
Subject(s) - medicine , analgesic , pain ladder , anesthesia , ketorolac , odds ratio , low back pain , confounding , population , physical therapy , opioid , alternative medicine , receptor , environmental health , pathology
Objectives To analyze and characterize the intake profile of pain‐relief drugs in a population‐based study of adults with chronic low back pain ( CLBP ). Methods EpiReumaPt was a cross‐sectional Portuguese population‐based study (10,661 subjects). Self‐reported active CLBP was considered to be low back pain on the day of enrollment and for ≥ 90 days. Prevalence and profile of analgesic intake was characterized among those self‐reporting active CLBP , taking into account the intensity of pain and the World Health Organization ( WHO ) analgesic ladder. We further investigated whether the presence of active CLBP was a factor independently associated with the intake of analgesics (adjusted for potential confounders). Results Among 1,487 subjects with active CLBP , only 18.7% were using analgesic/pain‐relief drugs. Estimated prevalence was anxiolytics, 14.1%; nonsteroidal anti‐inflammatory drugs ( NSAID s), 12.3%; antidepressants, 10.1%; analgesic, antipyretics, 6.6%; anticonvulsants, 3.4%; central muscle relaxants, 2.6%; and analgesic opioids, 1.6%. Most subjects with severe pain were in the first step of the WHO analgesic ladder: NSAID s plus anxiolytics (4.6%), NSAID s plus antidepressants (3.2%), or NSAID s plus muscle relaxants (2.5%). The presence of active CLBP was significantly associated with the intake of all therapeutic groups: antidepressants (odds ratio [ OR ] = 12.56; P < 0.001); centrally acting muscle relaxants ( OR = 12.01; P < 0.001); anticonvulsants ( OR = 9.27; P < 0.001); anxiolytics, sedatives, and hypnotics ( OR = 8.86; P < 0.001); NSAID s ( OR = 8.56; P < 0.001); and analgesic opioids ( OR = 8.13; P < 0.001). Conclusion Analgesic/pain‐relief drug intake in patients with active CLBP was very low, even for those with severe pain. The WHO analgesic ladder was carefully followed, with an extremely conservative use of analgesic opioids even for those with severe pain.