Background Managing chronic pain is challenging due to the long-term safety profile of most drugs. The treatment of chronic Low Back Pain (CLBP) represents a significant medical and financial burden and aims at relieving pain, improving functional ability, and preventing recurrence and chronicity. It is therefore important to gain insight into how CLBP is managed in the population.
Objectives To characterize the intake profile of analgesic and other pain relief drugs in the Portuguese adult population with CLBP, taking the World Health Organization (WHO) analgesic ladder and pain intensity into account. To assess the relationship between having CLBP and the intake of analgesic and other pain relief drugs.
Methods EpiReumaPt was a cross-sectional Portuguese population-based study (10,661 subjects). Self-reported active CLBP (ACLBP) was considered: LBP on the day of enrollment and for ≥90 days. Prevalence and profile of analgesic intake was characterized among those self-reporting ACLBP, taking into account the intensity of pain and the WHO analgesic ladder. To understand whether the presence of ACLBP was a factor associated with drug intake, multivariable logistic regressions were conducted for each of the analgesic/pain relief therapeutic groups (in separate models), adjusted for confounders.
Results Among 1,487 subjects with ACLBP, 18.7% were using analgesic/pain relief drugs. Estimated prevalences were: anxiolytics, 14.1%; NSAIDs, 12.3%; antidepressants, 10.1%; analgesic antipyretic, 6.6%; anticonvulsants, 3,4%; central muscle relaxants, 2.6%; opioids, 1.6%. Most subjects with severe pain were in the 1st step of the WHO analgesic ladder: NSAIDs plus anxiolytics, sedatives & hypnotics (4.6%); NSAIDs plus antidepressants (3.2%); NSAIDs plus central muscle relaxants (2.5%). The presence of ACLBP was significantly associated with the intake of all therapeutic groups (table):
Conclusions ACLPB was associated with the intake of drugs belonging to all analgesic drug classes. Nevertheless, this drug intake was very low, even for those with severe pain. The WHO analgesic ladder was carefully followed with an extremely conservative use of analgesic opioids even for those with severe pain. There is clearly an unmet need in what concerns pain management in patients with ACLBP, particularly taking into account the well-know burden of LBP.
Disclosure of Interest None declared