Some providers are more likely than others to hand out opioid prescriptions to patients undergoing spine imaging for lower back pain, new research suggests. Patient-level characteristics are also a strong factor.
Use of these medications has dropped in recent years, but opioids were still prescribed to 20% of patients who visited primary care for new back pain, a 2016 study shows. Now, experts have pinpointed patient, provider and clinical features associated with post-imaging prescriptions.
They found male image-ordering physicians were more likely to offer opioid drugs within 90 days of an exam and write multiple prescriptions for both opioids and non-opioid medications compared to their female peers.
And patients without comorbidities or who had more recent back imaging results on file were less likely to receive immediate opioids, the authors reported.
The team believes their results can help radiologists and other providers more closely align with recommended medication guidelines, they wrote in the September issue of the Journal of the American Board of Family Medicine.
“These findings could be useful in future studies to investigate how healthcare systems could identify opportunities to optimize pain medication management for individual patients,” Laura S. Gold, PhD, with the University of Washington Seattle’s Department of Radiology and co-authors added.
Gold et al. included nearly 240,000 patients in their analysis, which was part of a larger study investigating lumbar imaging reporting. About half the group (118,139) received at least one immediate pain prescription (opioid or non-opioid).
Approximately 87% of people given opioids 90 days post-imaging received more than one prescription from the same clinician who ordered the patient's first exam finalized by a radiologist, termed “index image.”
The authors found Asian patients undergoing imaging were less likely to receive pain meds compared to their white counterparts. Native Hawaiian/ Pacific Islanders, multiracial and Black patients all faced smaller odds of receiving opioids.
Individuals who had prescriptions before their index image had greater odds of receiving subsequent opioid or non-opioid medications. Middle-aged patients were also more likely to receive drugs compared to older individuals.
The group did not assess the appropriateness of prescription practices and didn’t track whether they were ever filled.
“Increasing knowledge regarding the characteristics of patients, providers, and clinics associated with the prescription of opioid or non-opioid medications for back pain may point to opportunities for optimizing care that is consistent with clinical guidelines,” Gold et al. wrote.
A few authors listed on the study reported potential conflicts of interest, including receiving royalties for writing topics on lower back pain and patents related to spine augmentation, among other disclosures.
Read more from the study here.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.