Vogt Molly T, Kwoh C Kent, Cope Doris K, Osial Thaddeus A, Culyba Michael, Starz Terence W
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Spine (Phila Pa 1976). 2005 May 1;30(9):1075-81. doi: 10.1097/01.brs.0000160843.77091.07.
Cross-sectional analysis of analgesic use by patients with low back pain (LBP).
To describe patterns of analgesic use and their cost implications for the use of other care services among individuals with LBP enrolled in a health insurance plan during 2001. It was hypothesized that the use of analgesics would be most frequent among patients with LBP with neurologic findings.
National guidelines have recommended analgesics as the primary pharmacologic treatment of LBP. The choice of specific analgesics has major cost and service use implications.
The University of Pittsburgh Health System includes 18 affiliated hospitals, more than 5000 physicians, and a commercial health plan with 255,958 members in 2001. This study uses the System Health Plan's insurance claims database to identify members who had services provided for one of 66 International Classification of Diseases, Version 9, Clinical Modification codes that identify mechanical LBP (n = 17,148).
In 2001, 7631 (43.5%) members with claims for LBP services had no analgesic pharmacy claims. The other 9517 (55.5%) had analgesics claims costing a total of $1.4 million; 68% of claimants were prescribed an opioid and 58% nonselective nonsteroidal antiinflammatory drugs (NSAID). The costs of opioids, NSAID, and cyclooxygenase-2 selective NSAID for patients with LBP represented 48%, 24%, and 28%, respectively, of total health plan expenditures for all uses of these drugs, including cancer. Opioid use was associated with the high volume usage of LBP care services. Patients with LBP with and without neurologic involvement and those with acquired lumbar spine structural disorders had similar patterns of analgesic use: those with congenital structural disorders were less likely to use analgesics; and those with psychogenic pain and LBP related to orthopedic devices were more likely to use opioids.
With this health plan, a high proportion of patients with LBP had claims for opioids during 2001. The use of opioids by patients with LBP represents a major cost for the health plan, and is associated with specific patient characteristics and their use of other LBP services.
对腰痛（LBP）患者的镇痛药使用情况进行横断面分析。
描述2001年参加医疗保险计划的LBP患者的镇痛药使用模式及其对使用其他护理服务的成本影响。研究假设是，在有神经学检查结果的LBP患者中，镇痛药的使用最为频繁。
国家指南推荐镇痛药作为LBP的主要药物治疗方法。特定镇痛药的选择对成本和服务使用有重大影响。
匹兹堡大学医疗系统包括18家附属医院、5000多名医生以及一个商业健康计划，2001年有255,958名成员。本研究使用该系统健康计划的保险理赔数据库，识别出因66个国际疾病分类第9版临床修订版代码之一（用于识别机械性LBP）而接受服务的成员（n = 17,148）。
2001年，7631名（43.5%）有LBP服务理赔记录的成员没有镇痛药药房理赔记录。其他9517名（55.5%）有镇痛药理赔记录，总费用为140万美元；68%的理赔者被开了阿片类药物，58%被开了非选择性非甾体抗炎药（NSAID）。LBP患者使用阿片类药物、NSAID和环氧化酶-2选择性NSAID的费用分别占该健康计划中这些药物包括癌症在内所有用途总支出的48%、24%和28%。阿片类药物的使用与LBP护理服务的高使用量相关。有和没有神经学受累的LBP患者以及患有后天性腰椎结构紊乱的患者有相似的镇痛药使用模式：患有先天性结构紊乱的患者使用镇痛药的可能性较小；患有精神性疼痛和与骨科器械相关的LBP的患者使用阿片类药物的可能性较大。
在这个健康计划中，2001年有很大比例的LBP患者有阿片类药物理赔记录。LBP患者使用阿片类药物对健康计划来说是一项主要成本，并且与特定的患者特征及其对其他LBP服务的使用相关。
