Prescription of
opioids for nonmalignant
musculoskeletal pain has increased substantially in recent years, but there is little information on the incidence of, or factors associated with, such prescription for work-related
back pain. In a prospective cohort study (N = 1,067), we examined associations between worker sociodemographic and other characteristics and
opioid prescription within six weeks of the first medical visit for workers' compensation claims for work loss due to
back injury. We examined administrative, pharmacy, and worker-reported data. In bivariate logistic regression models, Hispanics were less likely than non-Hispanic whites to receive
opioid prescriptions, and very high body mass index, daily tobacco use, greater
pain and physical disability,
pain radiating below the
knee, injury severity categorizations (from medical records) of major
sprain and
radiculopathy, and worse mental health were associated with
opioid prescription. Adjusting for demographics,
pain intensity, and physical disability,
opiate prescription was significantly associated with daily tobacco use,
pain radiating below the knee, and injury severity categories (major
sprain and
radiculopathy). Knowledge of worker characteristics associated with early
opioid prescription may be useful in future studies of the role of early
pain treatment in influencing subsequent course of
pain and disability among workers with
back injuries.
PERSPECTIVE: Little is known about patient characteristics that may influence physicians' decisions concerning prescription of
opioids for acute
back pain. Not surprisingly, workers with more severe
back injuries are more likely to be prescribed
opioids, but reasons for prescription disparities based on ethnicity and tobacco use warrant further study.