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bibliography * The PainScience Bibliography contains plain language summaries of thousands of scientific papers and others sources, like a specialized blog. This page is about a single scientific paper in the bibliography, Franklin 2009.

The longer people use opioids for back injury, the more they take and the less well they work

updated
Franklin GM, Rahman EA, Turner JA, Daniell WE, Fulton-Kehoe D. Opioid use for chronic low back pain: A prospective, population-based study among injured workers in Washington state, 2002-2005. Clinical Journal of Pain. 2009 Nov;25(9):743–51. PubMed #19851153.
Tags: back pain, bad news, medications, pain problems, spine, self-treatment, treatment

PainSci summary of Franklin 2009?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★★☆?4-star ratings are for bigger/better studies and reviews published in more prestigious journals, with only quibbles. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.

This is a detailed analysis of opioid use in over 1800 workers with back pain injuries, based on interviews and pharmacy data. Forty-two percent of them took opioids in the year after injury, and most (89%) started at or shortly after the first medical visit for the injury, and did not continue longer than about three months. However, 16 percent continued to take opioids for a full year. The long-term users increased their dosages quite a bit in that time, but only a quarter them actually got any better. For those who improved, opioid use did not increase.

The strongest predictor of longer-term opioid prescription was the total usage in the first quarter. Workers receiving at least 40mg of opioides per day in the first quarter were six times more likely to become long-term users.

~ Paul Ingraham

original abstractAbstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVES: To determine (1) the natural history of prescription opioid use, (2) the predictors of long-term opioid use, and (3) the association between opioid dose and pain and function in a large cohort of workers with recent back injuries.

METHODS: Prospective cohort of workers with back injuries (N=1883) interviewed 18 days (median) and 1 year after claim submission. Detailed pharmacy data were obtained from computerized records of paid bills.

RESULTS: Forty-two percent of workers (781/1843) received an opioid in the year after injury, most (694/781, 89%) at or shortly after the first medical visit for the injury. Of these, most (410/694, 59%) received opioids only within the first quarter after injury, whereas 16% (111/694) received opioids for 4 quarters. Among these long-term users, total morphine equivalent dose (MED) increased significantly (P<0.01) from the first (mean, 2364 mg; standard deviation, 4019 mg) to the fourth (mean, 3824 mg; standard deviation, 5998 mg) quarter. Improvement by at least 30% in pain and function measure scores occurred in only 26% (95% confidence interval 18%-36%) and 16% (95% confidence interval 10%-25%), respectively, of long-term users. Opioid doses increased substantially over time in all but those in whom function improved. After adjustment for baseline pain, function, and injury severity, the strongest predictor of longer term opioid prescription was total MED in the first quarter. Workers receiving at least 40 mg MED per day in the first quarter had 6-fold odds of receiving longer-term opioids. DISCUSSIONS: For the small group of workers with compensable back injuries who receive opioids longer-term (111/1843, 6%), opioid doses increase substantially and only a minority shows clinically important improvement in pain and function. The amount of prescribed opioid received early after injury strongly predicts long-term use. More research is needed to understand clinical decisions to continue or increase opioid therapy after back injury.


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