The Study: Relationship between early prescription dispensing patterns and work disability in a cohort of low back pain workers’ compensation claimants: a historical cohort study.

The Facts:

a. The authors wished to: “To examine and compare whether dispensing of prescription opioids, non-steroidal anti-inflammatory drugs (NSAIDs) and skeletal muscle relaxants (SMRs) within 8 weeks after a work-related low back pain (LBP) injury is associated with work disability.”

b. They looked at the claims regarding on the job injuries of 55,571 workers in British Columbia in Canada.

c. The workers received care for claims that were filed between 1998 and 2009.

d. They noted that other studies had noted an increase in work disability in workers who received opioids early in their care.

e. For over a decade there has been concern over the prescription of opioids to injured workers.

f. When looking at work disability, the authors did not find any advantage of opioids over NSAIDS and SMRs.

g. The authors felt that health care providers should try to avoid early usage of opioids in the care of workers suffering from low back injuries.

h. The authors found that workers who suffered low back injuries were more at risk for disability if they were prescribed opioids as compared to NSAIDs or muscle relaxers.

i. Those who received strong opioids were at a greater risk than those who received a prescription for a weaker opioid.

j. The authors also found a direct association between work disability and the number of days the patient used any of these drugs.

Take Home:

The stronger opioids have a greater risk compared to weaker opioids. If you gave the worker opioids as opposed to NSAIDs or muscle relaxers there was a greater risk. If you gave the worker more days of any of these drugs there was an association to greater work disability.

Reviewer's Comments:

More drugs, stronger drugs, more risk, duh!

Reviewer: Roger Coleman DC

Editor’s Comments: I thought the relationship between early opioid use and disability was interesting. It did occur to me that perhaps the correlation between disability and long term use of all drug types, including the NSAIDs, might be explained by the fact that more seriously injured people, the very group most likely to experience disability, are also the ones more likely to have a need for longer term courses of pain relievers.

Editor: Mark R. Payne DC

Reference: Carnide N, Hogg-Johnson S, Koehoorn M, Furlan AD, Cote P. Relationship between early prescription dispensing patterns and work disability in a cohort of low back pain workers’ compensation claimants: a historical cohort study. Occup Environ Med. 2019 Aug;76(8):573-581. doi: 10.1136/oemed-2018-105626. Epub 2019 May 15.

 Link to Abstract: https://www.ncbi.nlm.nih.gov/pubmed/31092628