MEDICATION USE FOR LOW-BACK-PAIN IN PRIMARY-CARE

Study Design. A longitudinal observational study of primary care patie nts with low back pain. Objectives. 1) To describe medications prescri bed for back pain, 2) to identify patient characteristics associated w ith type of drug therapy, 3) to determine if the prescription of certa in drugs is associated with better outcomes, and 4) to compare physici an prescribing behavior with national guidelines. Summary of Backgroun d Data, Few previous studies have focused on medication prescribing pa tterns for back pain in primary care. Methods. Two-hundred nineteen pa tients aged 20-69 years who were making a first visit for an episode o f back pain were studied. After the visit, patients completed question naires regarding sociodemographic characteristics, health status, back pain experience, and use of medications. Symptom severity and dysfunc tion were assessed by telephone 1 week after the visit. Results. Sixty -nine percent of patients were prescribed nonsteroidal anti-inflammato ry drugs, 35% muscle relaxants, 12% narcotics, and 4% acetaminophen. T wenty percent received no medications. Patients were more likely to re ceive medications if they had a desire for medication, pain below the knee, less than 3 weeks of pain before visit, more severe symptoms, or greater dysfunction. Patients with more severe symptoms were more lik ely to receive narcotics or muscle relaxants. Patients with greater dy sfunction were also more likely to receive narcotics. Type of drug the rapy predicted symptom severity but not dysfunction after 1 week. Cont rolling for other factors, those receiving medications had less severe symptoms after 1 week than patients who received no medication. Patie nts receiving both muscle relaxants and nonsteroidal anti-inflammatory drugs had the best outcomes. Medication use for back pain in this hea lth maintenance organization was generally concordant with national gu idelines. Conclusions, Nonsteroidal anti-inflammatory drugs, often aug mented by muscle relaxants, are a standard medical treatment for back pain in primary care. In this observational study, patients prescribed medications, particularly muscle relaxants, reported less severe symp toms after 1 week than those receiving no medications. However, random ized trials are needed to determine which medications or combinations of medications are most effective.