Background/Purpose: Chronic low back pain (cLBP) is a significant public health problem. Establishing treatment guidelines has been difficult due to heterogeneity of research data. Little is known about medication use for cLBP in the community.

Methods: We used data from the back pain survey, administered to a representative sample of US adults aged 20-69 (N = 5103) during the 2009-2010 cycle of the National Health and Nutrition Examination Survey (NHANES). Participants who reported pain in the area between the lower posterior margin of the ribcage and the horizontal gluteal fold at the time of survey with a history of pain lasting almost every day for at least 3 months were classified as having cLBP (N = 700). Data on prescription medications was collected by a trained interviewer, verified with medication bottles when available, and recorded into an electronic database. We used Lexicon Plus® categories to search for the commonly prescribed medications for chronic pain: acetaminophen, NSAIDs, narcotic analgesics (including tramadol), other neurologics (gabapentin, pregabalin), topical analgesics, skeletal muscle relaxants, antidepressants, anxiolytics. Chi-square tests, analysis of variance and adjusted logistic regression models were used for comparisons.

Results: 68.6% of US adults with cLBP aged 20-69 were taking at least one prescription medication in the past 30 days. 18.8% were using narcotic analgesics, 9.9% acetaminophen (including in combination with narcotics), 9.7% NSAIDs, 8.5% muscle relaxants, 6.9% gabapentin or pregabalin. COX2 inhibitors and topical lidocaine preparations were rarely used, 0.5% each. The prevalence of antidepressant and anxiolytic use was 20.2% and 8.5% respectively. The median number of days on the current prescription was 1009 for antidepressants (IQR 316-1945), 750 for anxiolytics (IQR 162-1845), 702 for narcotics (IQR 314-1770), 682 for muscle relaxants (IQR 258-1688), 534 for gabapentin or pregabalin (IQR 224-1611), and 522 for NSAIDs (IQR 155-1924). 

Conclusion: Despite recommendations to limit the use of narcotics in chronic pain and reports of increasing incidence of deaths due to narcotic overdose, narcotic analgesics along with antidepressants were the most prevalent prescription pain medications with extended duration of use in community-based US adults with chronic low back pain.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prescription-medication-use-in-community-based-us-adults-with-chronic-low-back-pain-nhanes-2009-2010/