Di Gangi Stefania, Bagnoud Christophe, Pichierri Giuseppe, Rosemann Thomas, Plate Andreas
Institute of Primary Care, University and University Hospital Zurich, Zürich, Switzerland.
Groupe Mutuel, Martigny, Switzerland.
J Pain Res. 2021 Oct 7;14:3109-3120. doi: 10.2147/JPR.S328033. eCollection 2021.
Low back pain (LBP) is one of the most frequent reasons for medical consultations. Literature suggests a large evidence-performance gap, especially regarding pain management. Therefore, the monitoring of treatment patterns is important to ensure high quality of treatment. This study aimed to describe treatment patterns specific to patients with diagnostic imaging of the spine for LBP.
The study was retrospective observational and based on health claims data from 2015 to 2019 provided by a Swiss health insurance company covering around 12% of the population. Patients, ≥18 years of age, with diagnostic imaging of the spine were included and observed 12 months before and after imaging. Patients with back surgery or comorbidities associated with the use of pain medications were excluded.
In total, 60,822 patients (mean age: 53.5 y, 56.1% female) were included and 85% received at least one pain medication. Of these, non-steroidal anti-inflammatory drugs, paracetamol, or opioids were prescribed in 88.6%, 70.7%, and 40.3% of patients, respectively. Strong opioids were used in 17% of patients given opioids. Patients with combinations of diagnostic imaging methods had the highest odds of receiving pain medication prescriptions (1.81, 95% CI: 1.66, 1.96, P < 0.001). Prescribed defined daily doses corresponded to short-term therapies.
Although the majority of patients received non-opioid short-term therapies, we found a substantial use of opioids, and in particular, a relative high usage of strong opioids. Our results highlighted the importance of both patient and healthcare provider awareness regarding the prudent treatment of LBP.
腰痛（LBP）是最常见的就医原因之一。文献表明，在证据与治疗效果之间存在很大差距，尤其是在疼痛管理方面。因此，监测治疗模式对于确保高质量治疗很重要。本研究旨在描述针对因LBP进行脊柱诊断成像的患者的治疗模式。
本研究为回顾性观察研究，基于一家瑞士健康保险公司提供的2015年至2019年的健康理赔数据，该公司覆盖约12%的人口。纳入年龄≥18岁且进行了脊柱诊断成像的患者，并在成像前后各观察12个月。排除接受过背部手术或有与使用止痛药物相关合并症的患者。
总共纳入了60822例患者（平均年龄：53.5岁，56.1%为女性），85%的患者至少接受了一种止痛药物治疗。其中，分别有88.6%、70.7%和40.3%的患者开具了非甾体抗炎药、对乙酰氨基酚或阿片类药物。在使用阿片类药物的患者中，17%使用了强效阿片类药物。采用多种诊断成像方法的患者接受止痛药物处方的几率最高（1.81，95%CI：1.66，1.96，P<0.001）。规定的限定日剂量相当于短期治疗。
尽管大多数患者接受了非阿片类短期治疗，但我们发现阿片类药物的使用相当普遍，尤其是强效阿片类药物的相对使用率较高。我们的结果强调了患者和医疗服务提供者对谨慎治疗LBP的认识的重要性。
