Early opioid prescription and subsequent disability among workers with back injuries: the Disability Risk Identification Study Cohort.

Abstract

STUDY DESIGN:

Prospective, population-based cohort study.

OBJECTIVE:

To examine whether prescription of opioids within 6 weeks of low back injury is associated with work disability at 1 year.

SUMMARY OF BACKGROUND DATA:

Factors related to early medical treatment have been little investigated as possible risk factors for development of long-term work disability among workers with back injuries. We have previously shown that about 1 of 3 of workers receive an opioid prescription early after a low back injury, and a recent study suggested that such prescriptions may increase risk for subsequent disability.

METHODS:

We analyzed detailed data reflecting paid bills for opioids prescribed within 6 weeks of the first medical visit for a back injury among 1843 workers with lost work-time claims. Additional baseline measures included an injury severity rating from medical records, and demographic, psychosocial, pain, function, smoking, and alcohol measures from a worker survey conducted 18 days (median) after receipt of the back injury claim. Computerized database records of work disability 1 year after claim submission were obtained for the primary outcome measure.

RESULTS:

Nearly 14% (254 of 1843) of the sample were receiving work disability compensation at 1 year. More than one-third of the workers (630 of 1843) received an opioid prescription within 6 weeks, and 50.7% of these (319 of 630) were received at the first medical visit. After adjustment for pain, function, injury severity, and other baseline covariates, receipt of opioids for more than 7 days (odds ratio = 2.2; 95% confidence interval, 1.5-3.1) and receipt of more than 1 opioid prescription were associated significantly with work disability at 1 year.

CONCLUSION:

Prescription of opioids for more than 7 days for workers with acute back injuries is a risk factor for long-term disability. Further research is needed to elucidate this association.

• Authors: Gary M Franklin, Bert D Stover, Judith A Turner, Deborah Fulton-Kehoe, Thomas M Wickizer, Disability Risk Identification Study Cohort
• Journal: Spine (Spine (Phila Pa 1976)) Vol. 33 Issue 2 Pg. 199-204 (Jan 15 2008) ISSN: 1528-1159 [Electronic] United States
• PMID: 18197107 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Analgesics, Opioid

Topics

• Adolescent
• Adult
• Aged
• Analgesics, Opioid (therapeutic use)
• Back Injuries (drug therapy, epidemiology, physiopathology)
• Cohort Studies
• Disability Evaluation
• Disabled Persons (statistics & numerical data)
• Female
• Humans
• Low Back Pain (drug therapy, epidemiology)
• Male
• Middle Aged
• Occupational Diseases (drug therapy, epidemiology, physiopathology)
• Pain Measurement
• Prospective Studies
• Risk Factors
• Severity of Illness Index
• Washington (epidemiology)
• Workers' Compensation (statistics & numerical data)