Background/Purpose:

An estimated 67% to 84% of persons residing in industrialized countries suffer from low back pain (LBP), and 2% of all workers are compensated for work days lost to back injuries.^1-3 Of the 29,886 occupational injuries reported in Kentucky in 2010-2011, 28% were low back injuries.⁴ The combined direct and indirect costs of LBP have been estimated to be 90 billion U.S. dollars annually.³ An estimated 13% of direct costs are spent on primary care and pharmacy services.¹ Many pharmaceuticals such as opioids have only “fair” evidence to support their use. Yet the number of opioid analgesic prescriptions for LBP have increased dramatically – In 1998, 16% of all opioid prescriptions were written for LBP, while 40% of opioid prescriptions were written for LBP in 2004.^2,3 In the Clinical Guidelines for the Diagnosis and Treatment of LBP, Chou and colleagues² recommend treating patients who fail self-care with proven non-pharmacologic therapies (ex. cognitive behavioral therapy) stating the level of evidence to support this therapy as “good.”² We will report the treatments provided to patients with the diagnosis of LBP using a private insurance dataset which represents a sample of 15 million patients annually across the US.

Methods:

We extracted de-identified patient health claims data from persons residing in Kentucky with the diagnosis of LBP or related terms using ICD-9 codes (ex. 724.2 (lumbago)) along with treatments received using CPT codes (ex. 97001 (physical therapy evaluation)) and medication records from January 1, 2007 to December 31, 2009. Descriptive statistics were used to report the percentage of patients receiving the various treatments for LBP.

Results:

Approximately 25% of patients with LBP received a service administered by a physical therapist (ex. evaluation, iontophoresis). Approximately 16% received exercise therapy and only 6% received psychological services. Similarly, despite the frequency in which occupation affects LBP, less than 1% of patients received occupational therapy (Table 1).² Yet, approximately 55% of patients filled a prescription for an opioid analgesic (Table 2).

Conclusion:

The various treatment options that are available for LBP are not received by patients in Kentucky, a predominantly rural, medically underserved state.⁵

Table 1.  Therapies among patients with the diagnosis of LBP in Kentucky (N=15,335).

Table 2.  Medication usage among patients with the diagnosis of LBP in Kentucky (N=15,335).