Advanced Analytics, Optum, Ann Arbor, Michigan.
Informatics and Data Science, Optum, Minnetonka, Minnesota.
Pain Med. 2019 Feb 1;20(2):252-266. doi: 10.1093/pm/pny007.
To examine the prevalence of musculoskeletal back pain among older adults stratified by pain medication intensity to 1) review treatment patterns and 2) consider targeted back pain prevention interventions.
A random sample of older adults age 64 years and older was utilized to identify new and recurring back pain. Prescription pain medications from drug claims were used to stratify to five unique intensity levels. The characteristics of each level were determined using regression models.
About 10% had musculoskeletal back pain. Of these, 54% (N = 20,645) had new back pain and 46% (N = 17,252) had recurring back pain. Overall, about 35% received physical therapy. Pain medication intensity levels included no prescription pain medications, nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, low-dose opioids, and high-dose opioids (new back pain: 39%, 10%, 6%, 23%, and 23%, respectively; recurring back pain 32%, 9%, 4%, 17%, and 38%, respectively). NSAID and muscle relaxant users were younger, healthier, and received physical therapy. Opioid users were younger, in poorer health, used sleep medications, received physical therapy, and had more falls and higher health care utilization and expenditures.
New and recurring back pain patients can be stratified by pain medication intensity to review treatment patterns and target back pain prevention programs. Those with back pain but taking no prescription pain medications may benefit from back pain prevention programs. More research on guidelines for treatment options for those on high levels of pain medications is warranted.
根据疼痛药物强度对老年人的肌肉骨骼背痛患病率进行分层，以 1）回顾治疗模式，2）考虑有针对性的背痛预防干预措施。
利用年龄在 64 岁及以上的老年人随机样本确定新的和复发的背痛。从药物索赔中使用处方止痛药将其分层为五个独特的强度级别。使用回归模型确定每个级别特征。
约 10%的老年人患有肌肉骨骼背痛。其中，54%（N=20645）有新的背痛，46%（N=17252）有复发性背痛。总体而言，约有 35%的人接受了物理治疗。疼痛药物强度级别包括无处方止痛药、非甾体抗炎药（NSAIDs）、肌肉松弛剂、低剂量阿片类药物和高剂量阿片类药物（新背痛：39%、10%、6%、23%和 23%；复发性背痛：32%、9%、4%、17%和 38%）。NSAID 和肌肉松弛剂使用者更年轻、更健康，并且接受了物理治疗。阿片类药物使用者更年轻，健康状况更差，使用睡眠药物，接受物理治疗，并且跌倒更多，医疗保健利用率和支出更高。
可以根据疼痛药物强度对新的和复发性背痛患者进行分层，以回顾治疗模式并针对背痛预防计划。那些有背痛但没有服用处方止痛药的人可能会受益于背痛预防计划。有必要对使用高剂量止痛药的治疗选择指南进行更多的研究。
