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

Ayman R. Ibrahim, Mohamed E. Elgamal, Moaz O. Moursi, Bara A. Shraim, Muath A. Shraim, Mujahed Shraim and Basem Al-Omari ()
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Ayman R. Ibrahim: College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
Mohamed E. Elgamal: College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
Moaz O. Moursi: College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
Bara A. Shraim: College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, 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

IJERPH, 2022, vol. 19, issue 19, 1-11

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.

Keywords: opioids; opiates; low back pain; return to work; sick leave; length of disability; systematic review (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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