Treatment Patterns in Patients with Diagnostic Imaging for Low Back Pain: A Retrospective Observational Study

Stefania Di Gangi,1 Christophe Bagnoud,2 Giuseppe Pichierri,1 Thomas Rosemann,1 Andreas Plate1 1Institute of Primary Care, University and University Hospital Zurich, Zürich, Switzerland; 2Groupe Mutuel, Martigny, SwitzerlandCorrespondence: Stefania Di GangiInstitute of Primary Care, University and University Hospital Zurich, Pestalozzistrasse 24, Zürich, CH-8091, SwitzerlandTel +41 44 255 75 02Fax +41 44 255 90 97Email Stefania.DiGangi@usz.chPurpose: 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.Patients and Methods: 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.Results: 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.Conclusion: 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.Keywords: low back pain medication, radiology, diagnostic imaging, NSAIDs, opioids, non-pharmacologic therapie