OBJECTIVES: The American College of Physicians guideline promotes the use of opioids for the short-term treatment of severe and unresponsive acute low back pain (LBP). However, limited evidence exists regarding self-reported pain levels and the extent of opioid use for LBP. This study assessed the association between self-reported pain severity and opioid utilization among patients with spine-related diseases (SRD) in the United States.

METHODS: This retrospective cross-sectional study utilized the 2018-2021 Medical Expenditure Panel Survey (MEPS) and included adult patients (age ≥ 18 years) with spine-related diagnoses based on the ICD-10 codes. The pain severity was part of SF-12 and addressed the extent of pain interference with normal work. The opioid use was assessed using prescription fill data from the pharmacy files. Descriptive weighted analyses were used to examine the characteristics of patients with SRD. A multivariable logistic regression model was used to estimate the odds of receiving opioids by pain severity levels while adjusting for covariates based on the Andersen Behavioral Model.

RESULTS: According to the MEPS, there were 18.67 (95%CI=18.66, 18.68) million patients with SRD. The extent of pain severity varied, with 25.17% reporting low; 11.34% reporting moderate; 12.18% reporting high; 9.68% reporting extreme and 30.64% reporting none. Overall, 2.79% (95%CI=2.67%, 2.90%) of SRD patients used opioids. The multivariable logistic regression model revealed that patients with extreme pain levels (aOR =1.49; 95%CI=1.04, 2.15) and high pain levels (aOR 1.68; 95%CI=1.24, 2.29) were more likely to use opioid medications compared with those with low pain severity levels.

CONCLUSIONS: This study found low overall use of opioids in patients with SRD. The likelihood of receiving opioids increased with pain severity. While the findings align with guideline recommendations, further research is needed to understand the long-term consequences of opioid use in SRD.