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The Association between Early Opioids Prescribing and the Length of Disability in Acute Lower Back Pain: A Systematic Review and Narrative Synthesis

Author

Listed:
  • Ayman R. Ibrahim

    (College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
    Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar)

  • Mohamed E. Elgamal

    (College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
    Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar)

  • Moaz O. Moursi

    (College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
    Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar)

  • Bara A. Shraim

    (College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
    Department of Plastic and Reconstruction Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar)

  • Muath A. Shraim

    (NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, QLD 4072, Australia)

  • Mujahed Shraim

    (Department of Public Health, College of Health Sciences, Qatar University, QU Health, Doha P.O. Box 2713, Qatar)

  • Basem Al-Omari

    (College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi P.O. Box 127788, United Arab Emirates
    KU Research and Data Intelligence Support Center (RDISC) AW 8474000331, Khalifa University of Science and Technology, Abu Dhabi P.O. Box 127788, United Arab Emirates)

Abstract

Background: There is conflicting evidence with respect to whether early opioid prescribing (EOP) within the first two weeks of acute Low Back Pain (LBP) onset is associated with the length of disability (LOD). The aim of this systematic review was to examine the relationship between EOP and LOD in individuals with acute LBP. Methods: A systematic search of Medline, EMBASE, and CINAHL was conducted. The Newcastle–Ottawa scale was used to assess the methodological quality of included studies. A narrative synthesis of findings was used owing to between-study heterogeneity. Results: Six cohort studies using workers’ compensation administrative data on 178,130 adults with LBP were included. Most studies were of good methodological quality. One study reported that LBP cases with EOP had higher LOD by 4 days than cases without EOP. Two studies reported that each 100 mg morphine equivalent amount (MEA) was associated with an increase in mean LOD by 0.4 day (95% confidence interval (CI): 0.3, 0.5) and 0.4 day (95% CI: 0.3, 0.4). One study showed that LBP cases with EOP had a higher hazard of continuation of time loss benefits by 1.94 (95% CI 1.86, 2.02). One study reported a dose–response relationship between MEA of EOP and LOD ranging between 5.2 days (95% CI 14.6, 25.0) for 1–140 mg MEA and 69.1 (95% CI 49.3, 89.0) for 450+ mg MEA. One study reported that LBP cases with EOP had a higher mean LOD by 3.8 days, but there was no statistically significant relationship between EOP and LOD (Hazard ratio 1.02; 95% CI 0.91, 1.13). Conclusions: The use of early opioid in the management of acute uncomplicated LBP is associated with prolonged disability duration. Further research on factors influencing inadequate adherence to evidence-based guidelines and optimal strategies to modify such factors may improve disability outcomes among patients presenting with acute LBP.

Suggested Citation

  • Ayman R. Ibrahim & Mohamed E. Elgamal & Moaz O. Moursi & Bara A. Shraim & Muath A. Shraim & Mujahed Shraim & Basem Al-Omari, 2022. "The Association between Early Opioids Prescribing and the Length of Disability in Acute Lower Back Pain: A Systematic Review and Narrative Synthesis," IJERPH, MDPI, vol. 19(19), pages 1-11, September.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:19:p:12114-:d:924493
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    References listed on IDEAS

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    1. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    2. Fraser W Gaspar & Matthew S Thiese & Kerri Wizner & Kurt Hegmann, 2021. "Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system," PLOS ONE, Public Library of Science, vol. 16(6), pages 1-12, June.
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